哮喘联盟

   摘要
   目的：现有的证据已经证明他汀类药物可作为皮质激素治疗哮喘的替代或辅助药物。
   概要：在动物模型中进行的他汀类药物抗炎作用和抗氧化作用的研究表明，降胆固醇药可能缓解哮喘动物长期使用皮质激素引起的不良反应。但是，在人群中的研究却产生混淆的结果。两项小样本安慰剂对照临床研究表明，他汀类药物对抑制哮喘炎症进展无效，但其作为辅助治疗的试验表明可使类固醇效应最小化。在两项共纳入超过1000例目前吸烟或曾吸烟的哮喘患者的研究中，他汀类药物的使用与一些患者哮喘急性发作减少和肺功能衰竭缓解有关。一项大型的基于人群的研究（n=3965）对哮喘患者平均随访4.5年后的结果表明，使用他汀类药物治疗与住院风险显著降低有关。一项较小规模的美国回顾性队列研究表明，接受他汀类药物治疗的患者1年发生哮喘相关性急诊的比率与未接受他汀类药物治疗的患者相比，显著降低(9.08% vs 4.18%)。他汀类药物使用的大部分研究和哮喘没有受混杂因素的影响,如患者合并症和药物的合用。
   结论：临床研究表明,对于哮喘患者他汀类药物治疗并不优于糖皮质激素，也不能增强吸入糖皮质激素的疗效。一些证据表明，他汀类药物可能有助于保护吸烟者伴阻塞性肺疾病的肺功能，减少哮喘吸烟患者和非吸烟患者的住院率。
 

（刘国梁 审校）
Am J Health Syst Pharm. 2013 Oct 1;70(19):1661-9. doi: 10.2146/ajhp120680.
 

Statins in the treatment of asthma.
 

Walker DY, Edwards KL.
 

ABSTRACT
PURPOSE: Current evidence on statin agents as potential alternatives or adjuncts to corticosteroid therapy for asthma is reviewed.
SUMMARY: Research showing antiinflammatory and antioxidant effects of statins in animal models suggested that the cholesterol-lowering drugs might be useful in mitigating the adverse effects of long-term corticosteroid therapy in patients with asthma, but studies in humans have yielded mixed results. Two small placebo-controlled clinical trials indicated that statins were not effective in combating asthmatic inflammatory processes, and trials of statins as adjunctive therapy have indicated minimal steroid-sparing benefits. In two studies involving a total of more than 1000 current and former smokers with asthma, statin use correlated with reduced acute asthma exacerbations and a slower decline of lung function in some patients. A large population-based study (n = 3965) found that statin therapy was associated with a significantly reduced risk of hospitalization for asthma after an average follow-up period of about 4.5 years; a smaller U.S. retrospective cohort study indicated a significantly lower 1-year rate of asthma-related emergency room visits among patients receiving statins relative to those not using statins (9.08% versus 4.18%). Much of the research on statins and asthma has not controlled for confounding influences such as patient comorbidities and concomitant medication use.
CONCLUSION: Clinical trials have shown that statin therapy is not superior to and does not enhance the beneficial effects of inhaled corticosteroids for the treatment of asthma. Some evidence suggests that statins may help preserve lung function in cigarette smokers with obstructive pulmonary disease and reduce hospitalizations in asthmatic smokers and nonsmokers.
 

Am J Health Syst Pharm. 2013 Oct 1;70(19):1661-9. doi: 10.2146/ajhp120