不同哮喘治疗方法对感冒诱发哮喘恶化风险的影响
2011/05/12
摘要
感冒常常导致哮喘恶化。本试验比较布地奈德/福莫特罗维持和缓解治疗期间及采用不同方案的皮质激素吸入(ICS) ±长效β2受体激动剂(LABA)治疗期间，与短效β受体激动剂(SABA)或LABA按需治疗期间，感冒相关严重哮喘恶化。在12507名进行为期6～12个月的双盲治疗的患者中，评价感冒和严重哮喘恶化（定义为采用口服皮质激素和/或住院/急诊治疗）。采用Poisson模型分析感冒出现后≤14天内发生的哮喘恶化。整个治疗期内感冒的发生率维持稳定。哮喘症状和缓解用药在感冒期间有所增加。与对照药物联合SABA治疗相比，布地奈德/福莫特罗维持和缓解治疗能减少感冒相关哮喘恶化（降低36%）（RR：0.64; P=0.002）。与相同维持剂量的ICS/LABA相比，上述治疗能使感冒相关哮喘恶化降低52%(RR 0.48; P<0.001)。与大剂量的ICS或ICS/LABA治疗相比，布地奈德/福莫特罗治疗在降低感冒相关哮喘恶化上无显著差异 (RR分别为0.83和0.72)。与按需SABA治疗相比（RR 0.96），按需LABA治疗不能减少感冒相关哮喘恶化。与ICS±LABA联合SABA按需治疗相比，布地奈德/福莫特罗维持和缓解治疗能减少感冒诱发的严重哮喘恶化。次级分析显示，ICS在降低感冒相关哮喘恶化中具有重要作用。有必要进一步研究哮喘恶化的原因，以便研究不同治疗的疗效。
（苏楠 审校）
Eur Respir J. 2011 Mar 15. [Epub ahead of print]
Effect of different asthma treatments on risk of cold-related exacerbations.
Reddel HK, Jenkins C, Quirce S, Sears MR, Bateman ED, O’Byrne PM, Humbert M, Buhl R, Harrison T, Brusselle GG, Thorén A, Sjöbring U, Peterson S, Ostlund O, Eriksson GS.
Woolcock Institute of Medical Research Sydney Australia.
Abstract
Common colds often trigger asthma exacerbations. This analysis compared cold-related severe exacerbations during budesonide/formoterol maintenance and reliever therapy and different regimens of maintenance inhaled corticosteroid (ICS) ± long-acting β2-agonist (LABA) with as-needed short-acting β2-agonist (SABA) or LABA. Reported colds, and severe exacerbations (defined by oral corticosteroid use and/or hospitalisation/emergency room visit) were assessed for 12507 patients during 6-12 months’ double-blind treatment. Exacerbations occurring ≤14 days after onset of reported colds were analysed by a Poisson model. Incidence of colds was similar across treatments. Asthma symptoms and reliever use increased during colds. Budesonide/formoterol maintenance and reliever therapy reduced severe cold-related exacerbations by 36% versus pooled comparators plus SABA (rate ratio [RR] 0.64; P=0.002), and, for individual treatment comparisons, by 52% versus same maintenance dose ICS/LABA (RR 0.48; P<0.001); there were non-significant reductions versus higher maintenance doses of ICS or ICS/LABA (RR 0.83 and 0.72). As-needed LABA did not reduce cold-related exacerbations versus as-needed SABA (RR 0.96). Severe cold-related exacerbations were reduced by budesonide/formoterol maintenance and reliever therapy compared with ICS±LABA with as-needed SABA. Subanalyses suggest the importance of the ICS component in reducing cold-related exacerbations. Future studies should document the cause of exacerbations, to allow identification of different treatment effects.
Eur Respir J. 2011 Mar 15. [Epub ahead of print]
感冒常常导致哮喘恶化。本试验比较布地奈德/福莫特罗维持和缓解治疗期间及采用不同方案的皮质激素吸入(ICS) ±长效β2受体激动剂(LABA)治疗期间，与短效β受体激动剂(SABA)或LABA按需治疗期间，感冒相关严重哮喘恶化。在12507名进行为期6～12个月的双盲治疗的患者中，评价感冒和严重哮喘恶化（定义为采用口服皮质激素和/或住院/急诊治疗）。采用Poisson模型分析感冒出现后≤14天内发生的哮喘恶化。整个治疗期内感冒的发生率维持稳定。哮喘症状和缓解用药在感冒期间有所增加。与对照药物联合SABA治疗相比，布地奈德/福莫特罗维持和缓解治疗能减少感冒相关哮喘恶化（降低36%）（RR：0.64; P=0.002）。与相同维持剂量的ICS/LABA相比，上述治疗能使感冒相关哮喘恶化降低52%(RR 0.48; P<0.001)。与大剂量的ICS或ICS/LABA治疗相比，布地奈德/福莫特罗治疗在降低感冒相关哮喘恶化上无显著差异 (RR分别为0.83和0.72)。与按需SABA治疗相比（RR 0.96），按需LABA治疗不能减少感冒相关哮喘恶化。与ICS±LABA联合SABA按需治疗相比，布地奈德/福莫特罗维持和缓解治疗能减少感冒诱发的严重哮喘恶化。次级分析显示，ICS在降低感冒相关哮喘恶化中具有重要作用。有必要进一步研究哮喘恶化的原因，以便研究不同治疗的疗效。
（苏楠 审校）
Eur Respir J. 2011 Mar 15. [Epub ahead of print]
Effect of different asthma treatments on risk of cold-related exacerbations.
Reddel HK, Jenkins C, Quirce S, Sears MR, Bateman ED, O’Byrne PM, Humbert M, Buhl R, Harrison T, Brusselle GG, Thorén A, Sjöbring U, Peterson S, Ostlund O, Eriksson GS.
Woolcock Institute of Medical Research Sydney Australia.
Abstract
Common colds often trigger asthma exacerbations. This analysis compared cold-related severe exacerbations during budesonide/formoterol maintenance and reliever therapy and different regimens of maintenance inhaled corticosteroid (ICS) ± long-acting β2-agonist (LABA) with as-needed short-acting β2-agonist (SABA) or LABA. Reported colds, and severe exacerbations (defined by oral corticosteroid use and/or hospitalisation/emergency room visit) were assessed for 12507 patients during 6-12 months’ double-blind treatment. Exacerbations occurring ≤14 days after onset of reported colds were analysed by a Poisson model. Incidence of colds was similar across treatments. Asthma symptoms and reliever use increased during colds. Budesonide/formoterol maintenance and reliever therapy reduced severe cold-related exacerbations by 36% versus pooled comparators plus SABA (rate ratio [RR] 0.64; P=0.002), and, for individual treatment comparisons, by 52% versus same maintenance dose ICS/LABA (RR 0.48; P<0.001); there were non-significant reductions versus higher maintenance doses of ICS or ICS/LABA (RR 0.83 and 0.72). As-needed LABA did not reduce cold-related exacerbations versus as-needed SABA (RR 0.96). Severe cold-related exacerbations were reduced by budesonide/formoterol maintenance and reliever therapy compared with ICS±LABA with as-needed SABA. Subanalyses suggest the importance of the ICS component in reducing cold-related exacerbations. Future studies should document the cause of exacerbations, to allow identification of different treatment effects.
Eur Respir J. 2011 Mar 15. [Epub ahead of print]
上一篇：
严重哮喘的激素抵抗：当前的机制研究和未来的治疗方向
下一篇：
城区哮喘儿童奥玛珠单抗（IgE抗体）治疗的随机试验
