吸入糖皮质激素的全身副作用

长期大剂量吸入糖皮质激素治疗支气管哮喘有导致全身作用的潜在危险，主要包括对肾上腺的抑制作用和对骨代谢及生长发育的影响。     

低剂量吸入糖皮质激素治疗轻度支气管哮喘回顾性分析

目前指南不再推荐β2受体激动剂单独用于轻度持续性支气管哮喘（简称哮喘）的规律治疗,而最近临床研究支持吸入糖皮质激素（inhaled corticosteroids,ICS）对轻度持续性哮喘具有明显的益处。本文从轻度哮喘患者的气道炎症特点,ICS的使用策略及其联合用药方面,对近年有关ICS治疗轻度哮喘这一问题进行回顾性分析,为轻度哮喘的治疗提供参考意见。     

低剂量吸入糖皮质激素治疗轻度支气管哮喘回顾性分析

目前指南不再推荐β_2受体激动剂单独用于轻度持续性支气管哮喘(简称哮喘)的规律治疗,而最近临床研究支持吸入糖皮质激素(inhaled corticosteroids,ICS)对轻度持续性哮喘具有明显的益处.本文从轻度哮喘患者的气道炎症特点,ICS的使用策略及其联合用药方面,对近年有关ICS治疗轻度哮喘这一问题进行回顾性分析,为轻度哮喘的治疗提供参考意见.     

吸入型糖皮质激素副作用的研究进展

本文综述了吸入型糖皮质激素对全身系统的不利影响及国外新的研究进展。高剂量的任何吸入型糖皮质激素都会产生具有临床意义的全身活性。中等剂量的吸入型糖皮质激素可抑制下丘脑-垂体-肾上腺轴的功能,但无明显的临床意义。吸入型糖皮质激素在短期内抑制了患儿的生长速度,但整体影响小,且不会持续不变。骨质疏松、骨折的发生与吸入型糖皮质激素在高剂量时有明显的剂量依赖关系。     

吸入糖皮质激素的全身副作用

长期大剂量吸入糖皮质激素治疗支气管哮喘有导致全身副作用的潜在危险,主要包括对肾上腺的抑制作用和对骨代谢及生长发育的影响。     

糖皮质激素吸入治疗支气管哮喘患者二年观察

我们以中等剂量的二丙酸倍氯米松（ＢＤＰ）为开始剂量,治疗支气管哮喘（哮喘）２０例,临床观察了２年,现报告如下。对象与方法哮喘患者２０例,男１５例,女５例,年龄１９～６０岁,病程３～２１年,接受观察时２０例患者均处于哮喘急性发作期,其中轻度发作７例,中...     

吸入皮质醇激素治疗支气管哮喘的副作用

吸入皮质醇激素 (ＩＣＳ)已广泛应用于支气管哮喘患者的治疗 ,其疗效确切 ,能显著改善哮喘症状 ,减少其他药物如口服激素的剂量 ,还能降低肺功能远期损害的危险性。ＩＣＳ最重要的特性是在局部发挥强大的作用 ,而全身的不良反应少见 ,迄今几乎没有见到对生命造成威胁的副作用的报道 ,一些新的制剂如丙酸氟替卡松 (ＦＰ)尤为如此。但是 ,随着疗效更强的制剂不断上市 ,给药浓度不断提高以及给药系统的不断改进 ,ＩＣＳ的推广前景必将更为广阔。这些因素无形中增加了ＩＣＳ的副作用的可能性 ,这也是临床医生、患者及其家人共同关心的问题。一、…     

吸入糖皮质激素对哮喘患者肾上腺皮质功能的影响

吸入糖皮质激素目前已作为哮喘的首选用药。然而长期使用的安全性仍有待阐明。我们的研究观察了我国哮喘患者中长期吸入丙酸倍氯米松(ＢＤＰ)对肾上腺皮质功能的影响。对象与方法　所有观察对象均来自我院哮喘门诊,符合支气管哮喘诊治标准[1],根据用药情况分组观察。吸入组:25例患者中男11例,女14例,年龄(43±9)岁,病程(12±11)年。一秒钟用力呼气容积占预计值百分比(ＦＥＶ1占预计值%)为(63±17)%。吸入ＢＤＰ5个月以上,实验前6个月内全身未用糖皮质激素,吸入剂量每天300～800μｇ,平均每天467μｇ。对照组:15例患者中男7例,女8例,年龄(40…     

吸入类固醇对哮喘的疗效与副作用

吸入类固醇可通过抑制气道慢性炎症，降低气道对有害刺激物的反应缓解哮喘症状，慢性重症哮喘患需早期，大量，长期用药，其中少数患可引起局部或全身副作用，需要进一步探讨。     

糖皮质激素吸入疗法对哮喘患儿生长发育的影响

糖皮质激素吸入疗法对哮喘儿童身高的影响日益受到人们的关注。由于儿童生长是一复杂过程，本文综述了哮喘严重程度及口服，汲人糖皮质激素对哮喘儿童生长发育的影响，并对合理使用不同剂型的吸入药物、降低这一副作用提出相关建议。     

吸入性糖皮质激素增加哮喘患者肺炎风险

目的 探讨哮喘患者长期吸入激素(ICS)是否增加肺炎发生风险.方法 选择上海市杨浦区市东医院07年1月～ 07年12月哮喘患者共300例,其中使用ICS者156例(A组),未使用者144例(B组),并选择同期健康志愿者150例(C组).结果 随访6、12、18、24个月结束时,A组患者ICS使用总量分别为28.50 g、50.10 g、61.30 g、69.10 g,发生肺炎分别为10、23、37、53例次;B组发生肺炎分别为7、14、22、29例次;C组发生肺炎分别为9、16、26、33例次.B组和C组比较差异无统计学意义(P＞0.05).A组和B组、C组比较差异有统计学意义(P＜0.05).结论 长期使用ICS增加肺炎风险,随着剂量和时间增加,肺炎发病机会增高,但预后良好.     

长期吸入糖皮质激素对哮喘患者某些骨代谢指标的影响

目的 了解南京地区哮喘患长期吸入类固醇糖皮质激素（GCS）是否会引起骨质丢失。方法 采用双能X线骨密度仪（DEXA）和放免法等分别测定20例每日坚持吸GCS大于等于五个月的哮喘患的骨密度（BMD）、血骨钙素（BGP）等指标,并同期配对20例未使用GCS的哮喘患进行对比分析。结果 显示两组病人BMD和BGP等各指标之间无显差异,P＞0．05。结论 在一定限度内长期吸入GCS控制哮喘,对骨代谢不产生明显影响。     

小剂量吸入必可酮对哮喘患者的疗效观察

目的；研究小剂量吸入激素与大剂量吸入激素对中度哮喘患症状、肺功能改善的影响。方法：通过4周较大剂量必可酮（BDP）600mg,每日2次治疗，47例中度哮喘患随机分为2组，包括A组吸入DBP300mg,每日2次；B组BDP100mg，每日2次，并加用舒弗美200mg口服，每晚1次，治疗共6个月。结果：4周大剂量基础治疗后，患症状明显缓解，肺功能明显改善，并且在以后的治疗研究阶段患多较稳定，多数无急性发作。在实验观察4月后，B组舒喘灵使用次数明显低于A组，比较差异有显性（P＜0．01）。结论：研究结果显示，大剂量吸入并加用茶硷似有更好疗效。     

High-dose inhaled corticosteroids and add-on therapy use in adults with asthma in the UK in 2003: an observational study.

AIMS: To quantify use of high dose inhaled corticosteroids (ICS) and add-on therapy in adults, and children aged 12 and over, in the community. METHODS: Cross-sectional observational survey of UK general practice prescribing records from July 2002 to June 2003 utilising the Doctors Independent Network clinical database. RESULTS: 30,895 patients aged 12 and over were treated for asthma with inhaled corticosteroids, with a quantifiable daily dose recommendation in 22,027 cases. Twenty-seven percent (95% Confidence Intervals 26-28%) were prescribed 'high-dose' ICS (>800 mcg/day beclomethasone or equivalent). Of these, 32% (31-33%) were not currently prescribed add-on therapy (long acting B2 agonists, leukotriene antagonists, theophylines), and most of these (84%, 82-86%) had never received a prior trial of add-on therapy. CONCLUSIONS: High dose ICS therapy was commonly prescribed to people with asthma, frequently without co-prescribed add-on therapy. Many adults with more severe asthma may be receiving treatment that does not accord with current evidence of best practice.     

Bone mineral density and bone metabolism of prepubertal children with asthma after long-term treatment with inhaled corticosteroids

Little is known about the effect of long-term treatment with inhaled corticosteroids (ICS) on bone mineral density (BMD) in asthmatic children. In the present cross-sectional study BMD, bone metabolism, height, body composition, and bone age were evaluated in 40 prepubertal children (21 boys) with asthma, treated with a moderate to high dose of ICS over a period of 3 to 8 years. Body composition and BMD of the lumbar spine and total body were measured by Dual Energy X-ray Absorptiometry. BMD results were compared with 148 prepubertal healthy children of the same population. Blood samples were taken for the determination of biochemical bone parameters. The asthmatic children had decreased height, lean tissue mass and fat mass, and a delay of bone maturation, indicating growth retardation. ICS-treated asthma was negatively correlated with total body BMD in a multiple regression model with adjustment for age, gender, height and weight (P = 0.01). Duration of ICS therapy correlated negatively with total body BMD when it was added to the model (P = 0.01). Lumbar spine BMD was not affected by ICS in children with ICS-treated asthma. If age of the asthmatic children was replaced by their bone age in the model, no significant correlation was found between ICS-treated asthma and total body or lumbar spine BMD. The biochemical parameters of bone metabolism were within normal limits. In conclusion, children with asthma who have used ICS daily for 3 to 8 years had lower total body BMD than healthy controls. Long-term longitudinal studies are needed to investigate whether these children attain a normal peak bone mass. Pediatr. Pulmonol. 1997; 24:379–384. © 1997 Wiley-Liss, Inc.     

Systemic side effects of inhaled corticosteroids in patients with asthma

Asthma is a complex disease of the respiratory tract associated with chronic inflammation in which an intricate network of cells and cellular factors plays a major role. Asthma is one of the most common chronic diseases, with an estimated 300 million cases worldwide, imposing a considerable burden on society in morbidity, quality of life, and healthcare costs. Inhaled corticosteroids (ICSs) form the gold standard, first-line therapy in the effective management of persistent asthma and reduce morbidity and mortality from asthma. However, long-term use of high-dose ICS therapy has potential to cause systemic side effects-impaired growth in children, decreased bone mineral density, skin thinning and bruising, and cataracts. Hypothalamic-pituitary-adrenal-axis suppression, measured by serum or urine cortisol decrease, correlates with the occurrence of systemic side effects of high-dose ICSs. Therefore, cortisol may be a relevant surrogate marker to identify the potential for adverse effects from ICS therapy. Ciclesonide is a new generation ICS with demonstrable safety and efficacy in the treatment of asthma. The unique pharmacologic characteristics of ciclesonide, such as reduced local adverse effects, lack of cortisol suppression, and the option for once-daily dosing, may improve compliance with therapy and allow long-term use of ICSs without fear of systemic adverse effects.     

全球哮喘防治创议推荐糖皮质激素的半量吸入分级治疗支气管哮喘患者的疗效分析

目的为减轻支气管哮喘(简称哮喘)患者的经济负担,探讨中国控制哮喘最小吸入糖皮质激素(ICS)剂量。方法86例患者随机分为:(1)G组42例:应用全球哮喘防治创议(GINA)推荐高限剂量,中度患者每次250μg,每天2次;重度患者每次375μg,每天2次;(2)H组44例:应用G组剂量半量,中度患者每次125μg,每天2次;重度患者早晨125μg、晚上250μg,每天各1次。采用随机、对照、平行分组、多中心临床研究,筛选期1周仅按需吸入沙丁胺醇。治疗期共24周。结果治疗后G和H组日间症状评分:重度哮喘G组为(0.7±0.8)分,H组为(0.4±0.6)分,中度G组为(0.4±0.5)分,H组为(0.3±0.5)分;第一秒用力呼气容积(FEV1):重度G组为(1.5±0.5)L,H组为(1.8±0.6)L,中度G组为(2.3±0.6)L,H组为(2.3±0.8)L;第一秒用力呼气容积占预计值百分比(FEV1占预计值%):重度G组为(54±17)%,H组为(59±19)%,中度G组为(79±14)%,H组为(79±15)%;晨间最大呼气流量(PEF)增加值:中、重度G组分别为45、67L/min,中、重度H组分别为56、65L/min;夜间憋醒天数:重度G、H组分别为81、69d;无症状天数:重度G、H组分别为88、98d;合并用沙丁胺醇剂量(重度G、H组分别为5.0、3.4喷/d)等32项(次)比较差异均无统计学意义(P均>0.05)。G组中度哮喘患者首次加重3例,H组为11例,两组比较差异有统计学意义(χ2=4.74,P<0.05);G组中度哮喘控制例数为18例,H组为12例,两组比较差异有统计学意义(χ2=4.97,P<0.05);而G组中度哮喘患者夜间症状评分为(0.30±0.22)分,H组为(0.13±0.33)分,两组比较差异有统计学意义(t=-2.06,P<0.05)、重度哮喘加重天数G组为11d,H组为6d,两组比较差异有统计学意义(U=31.00,P<0.05)。结论大多数中国哮喘患者应用GINA推荐的ICS高限剂量与其半量分级治疗,可取得相似的疗效。     

大剂量吸入糖皮质激素的安全性

吸入性糖皮质激素因其有效的抗炎作用广泛应用于多种呼吸系统疾病治疗中。长期大剂量吸入糖皮质激素的安全性正引起广泛重视,这也成为近年来研究的焦点。本文就大剂量吸入糖皮质激素的安全性（全身反应及局部反应）作一综述。     

Limited treatment adaptation despite poor asthma control in asthma patients treated with inhaled corticosteroids

Objective: Current asthma guidelines recommend use of inhaled corticosteroids (ICS) in patients with persistent disease. This study was designed to investigate (1) the proportion of patients prescribed ICS-containing maintenance treatment who achieve asthma control, (2) determinants of control and (3) how physicians adapt treatment to the level of control. Methods: General practitioners (GPs) and chest physicians (CPs) in France recruited patients consulting for asthma and prescribed an ICS. Over a 2-year follow-up period, asthma symptoms in the previous 3 months and treatments prescribed were documented at each visit. Variables independently associated with asthma control were determined by multiple logistic regression. Results: Data were available for 924 patients recruited by GPs and 455 recruited by CPs. Asthma control was acceptable in only 24% of patients at inclusion, and in 33.6% at the last follow-up visit. Five factors were independently associated with asthma control: age (or time since diagnosis), gender, smoking status, allergic aetiology of asthma and treatment. Most patients (56.3%) were prescribed the same ICS dose regimen at the end of follow-up as at inclusion. The intensity of controller therapy had been increased in only 12.2% of patients unacceptably controlled at inclusion. Conclusions: Asthma was unacceptably controlled in most patients receiving ICS-containing maintenance treatment and remained so during follow-up. Despite this, treatment adaptations by GPs and CPs were very infrequent. This unsatisfactory situation may be improved by adopting a more dynamic approach to tailoring controller therapy to the needs of the patient.