布地奈德/福特莫罗紧急联合用药可通过降低运动导致的支气管狭窄来改善哮喘控制
2013/12/04
摘要
背景：在轻度哮喘中，对于运动导致的支气管痉挛（EIB），常常立即使用吸入性短效β2受体拮抗剂治疗。
目的：我们提出的假说是布地奈德和福特莫罗联合紧急治疗可降低EIB，疗效与吸入常规布地奈德同等并高于紧急吸入特布他林。
方法：在一项为期6周、双盲、平行组研究中（ClinicalTrials.gov identifier: NCT00989833），将66例确诊EIB的哮喘患者（>12岁）随机分为三组：特布他林（0.5 mg）紧急治疗、常规布地奈德（400 μg）和特布他林（0.5 mg）联合紧急治疗、布地奈德（200 μg）和福莫特罗（6 μg）联合紧急治疗。要求患者每周进行3-4次治疗。主要结果为研究用药末次给药后24h内EIB。
结果：经过6周常规布地奈德或布地奈德+福特莫罗紧急治疗后，最大运动后用力呼气量1s下降值和末次给药24小时后下降值分别为6.6%（平均值;95%CI -10.3~ -3.0）和5.4% (-8.9~ -1.8)。两组治疗疗效优于紧急吸入特布他林（+1.5%; -2.1 ~+5.1）。布地奈德+福特莫罗联合组的布地奈德总剂量相比常规布地奈德组降低2.5倍。三组对额外医疗保健的需要情况类似。
结论：布地奈德和福莫特罗紧急联合用药可通过降低EIB改善哮喘控制情况，尽管总类固醇剂量显著降低，但其疗效与常规布地奈德治疗相当。这两种治疗均优于特布他林紧急治疗，特布他林不能改变支气管对运动的反应。研究结果对仅仅推荐SABAs治疗轻度哮喘EIB提出了质疑。
（苏楠 审校）
Thorax. 2013 Oct 3. doi: 10.1136/thoraxjnl-2013-203557. [Epub ahead of print]
Combination of budesonide/formoterol on demand improves asthma control by reducing exercise-induced bronchoconstriction.
Lazarinis N, Jørgensen L, Ekström T, Bjermer L, Dahlén B, Pullerits T, Hedlin G, Carlsen KH, Larsson K.
ABSTRACT
BACKGROUND: In mild asthma exercise-induced bronchoconstriction (EIB) is usually treated with inhaled short-acting β2 agonists (SABAs) on demand.
OBJECTIVE: The hypothesis was that a combination of budesonide and formoterol on demand diminishes EIB equally to regular inhalation of budesonide and is more effective than terbutaline inhaled on demand.
METHODS: Sixty-six patients with asthma (>12 years of age) with verified EIB were randomised to terbutaline (0.5 mg) on demand, regular budesonide (400 μg) and terbutaline (0.5 mg) on demand, or a combination of budesonide (200 μg) + formoterol (6 μg) on demand in a 6-week, double-blind, parallel-group study (ClinicalTrials.gov identifier: NCT00989833). The patients were instructed to perform three to four working sessions per week. The main outcome was EIB 24 h after the last dosing of study medication.
RESULTS: After 6 weeks of treatment with regular budesonide or budesonide+formoterol on demand the maximum post-exercise forced expiratory volume in 1 s fall, 24 h after the last medication, was 6.6% (mean; 95% CI -10.3 to -3.0) and 5.4% (-8.9 to -1.8) smaller, respectively. This effect was superior to inhalation of terbutaline on demand (+1.5%; -2.1 to +5.1). The total budesonide dose was approximately 2.5 times lower in the budesonide+formoterol group than in the regular budesonide group. The need for extra medication was similar in the three groups.
CONCLUSIONS: The combination of budesonide and formoterol on demand improves asthma control by reducing EIB in the same order of magnitude as regular budesonide treatment despite a substantially lower total steroid dose. Both these treatments were superior to terbutaline on demand, which did not alter the bronchial response to exercise. The results question the recommendation of prescribing SABAs as the only treatment for EIB in mild asthma.
Thorax. 2013 Oct 3. doi: 10.1136/thoraxjnl-2013-203557. [Epub ahead of print]
