哮喘联盟

   摘要
   背景：支气管哮喘主要是通过吸入糖皮质激素(ICS)治疗来控制的，停用ICS治疗将会加重哮喘症状并减弱呼吸功能。然而，ICS对成人患者肺功能的纵向影响还未知。
   方法：为了确定常规使用ICS治疗是否可以预防成人支气管哮喘患者长期的肺功能恶化，共纳入167例1995年在福冈国立医院首诊的成人哮喘患者，并分别在1995、1996和2010年进行了肺功能测试。102例患者继续规律ICS治疗(常规组)，39例患者接受不定期的ICS治疗(非常规组)。回顾性比较两组间的肺功能变化。同时也分析吸烟、疾病严重程度和病程的影响。
   结果：开始治疗后一年常规组第1秒用力呼气量(FEV1)值增加，非常规组则减少。在第15年时，非常规组的预测FEV1%比常规组降低更多(p < 0.05)；常规组FEV1每年下降28.2 ml(SD 24.5)，非常规组每年下降44.6 ml(SD 32.5) (p < 0.05)。尽管规律ICS治疗，但与不吸烟者相比，吸烟者FEV1下降的更多，并且重度哮喘患者FEV1下降的幅度要比轻度或间断性哮喘的患者更多。ICS延迟治疗也会降低年FEV1值。
   结论：当症状较轻时尽早规律ICS，可预防肺功能的显著恶化。哮喘患者吸烟应被强烈劝戒。
 

（林江涛 审校）
Int Arch Allergy Immunol. 2013 Oct 25;162(4):323-329. [Epub ahead of print]
 

Impact of Inhaled Corticosteroid Treatment on 15-Year Longitudinal Respiratory
Function Changes in Adult Patients with Bronchial Asthma.
 

Shimoda T, Obase Y, Kishikawa R, Iwanaga T.
 

ABSTRACT
BACKGROUND: Bronchial asthma is mainly controlled by inhaled corticosteroid (ICS) treatment, and discontinuation of ICS treatment can worsen asthma symptoms and reduce respiratory function. However, the longitudinal impact of ICS on lung function in adult patients is unknown.
METHODS: To determine whether regular ICS treatment can prevent long-term lung function deterioration in adults with bronchial asthma, we recruited 167 adult asthma patients who first visited Fukuoka National Hospital in 1995 and underwent lung function tests in 1995, 1996 and 2010. Regular ICS treatment was continued in 102 patients (regular group), while 39 patients received irregular ICS treatment (irregular group). Changes in lung function were compared retrospectively between the groups. The influences of smoking, disease severity and disease duration were also analyzed.
RESULTS: The forced expiratory volume in 1 s (FEV1) values increased in the regular group 1 year after the initiation of therapy, but they decreased in the irregular group. At year 15, the predicted FEV1% had decreased significantly more in the irregular group than in the regular group (p < 0.05); FEV1 decreased by 28.2 ml/year (SD 24.5) in the regular group and by 44.6 ml/year (32.5) in the irregular group (p < 0.05). The decrease in FEV1 was greater in smokers than in nonsmokers, despite regular ICS treatment, and it was significantly greater in patients with severe asthma than in those with mild or intermittent disease. Delay in ICS initiation also affected the annual FEV1 decrease.
CONCLUSIONS: Regular ICS, introduced early when symptoms are mild, could prevent lung function from worsening significantly. Smoking should be strongly discouraged in asthma patients.
 

Int Arch Allergy Immunol. 2013 Oct 25;162(4):323-329. [Epub ahead of print]