长期雾化吸入糖皮质激素治疗支气管哮喘对患儿生长发育的影响

目的探究长期雾化吸入糖皮质激素治疗支气管哮喘对患儿生长发育的影响。方法选取行长期使用糖皮质激素雾化治疗的50例支气管哮喘患儿作为研究组,另选取同期健康体检者50例作为对照组。比较两组入组时和入组2年后的身高、体重以及胰岛素样生长因子-1(IGF-1)、骨声波速度(SOS)水平。结果入组时,两组身高、体重比较,差异无统计学意义(P>0.05);入组2年后,研究组身高(104.34±2.67)cm、体重(17.85±1.24)kg均优于入组时的(97.83±2.15)cm、(15.64±1.34)kg,对照组身高(104.76±2.58)cm、体重(17.95±1.34)kg均优于入组时的(97.67±2.09)cm、(15.83±1.56)kg,差异均具有统计学意义(P<0.05)。两组入组2年后身高、体重比较,差异无统计学意义(P>0.05)。两组入组时和入组2年后IGF-1、SOS水平组间组内比较,差异均无统计学意义(P>0.05)。结论支气管哮喘患儿使用糖皮质激素长期雾化吸入治疗,不会影响生长发育。     

长期吸入小剂量糖皮质激素治疗小儿哮喘对生长发育肺功能及骨代谢影响的观察

目的探讨长期吸入小剂量糖皮质激素治疗小儿哮喘的临床疗效及对肺功能、钙磷代谢的影响。方法对26例持续吸入二丙酸倍氯米松（100-300μg/d）,疗程1.5-2年的哮喘患儿进行风流速值（peak expiratory flow,PEF）及钙（Ca2＋）、磷（P3-）及碱性磷酸酶（AKP）监测。并对照同期正常小儿的身高体重增长速度。结果长期吸入小剂量二丙酸倍氯米松,对生长发育及钙磷代谢无影响。结论糖皮质激素作为一线药物应用,长期小剂量吸入对小儿哮喘疗效好,对生长发育无影响。     

小剂量糖皮质激素布地奈德吸入在支气管哮喘治疗中的应用

目的探讨小剂量布地奈德粉吸入治疗支气管哮喘的临床疗效及作用机制。方法将我院收治的98例支气管哮喘患者按照分层随机分组法分为观察组和对照组。对照组给予口服全身糖皮质激素、β2受体激动剂及氨茶碱等常规治疗药物;观察组给予小剂量布地奈德粉雾剂吸入。观察两组患者肺功能改善情况、临床疗效及血浆皮质醇浓度。结果治疗后,观察组气道阻力(Raw)与气道传导率(Gaw)分别为154.6%±12.3%、85.1%±7.5%,气道高反应性(BHR)正常患者占50.8%(32/63);对照组Raw和Gaw分别为324.1%±27.6%、56.7%±6.1%,BHR正常患者占27.8%(10/36),两组比较差异有统计学意义(P<0.05)。观察组、对照组的临床总有效率分别为92.1%(58/63)、63.9%(23/36),两组比较差异有统计学意义(P<0.05)。观察组治疗前、后的血浆皮质醇浓度分别为(317.7±54.9)、(324.5±43.8)nmol/L,治疗前后比较差异无统计学意义(P>0.05);观察组治疗前经ACTH刺激后血浆皮质醇浓度为(371.2±37.5)nmol/L,治疗后经ACTH激发的血浆皮质醇浓度为(366.2±45.8)nmol/L,治疗前后比较差异无统计学意义(P>0.05)。结论小剂量布地奈德粉雾剂吸入治疗支气管哮喘疗效显著,长期使用不会引起HPAA功能抑制。     

吸入糖皮质激素对哮喘急性发作患儿血浆血小板活化因子水平的影响

目的:通过对吸入糖皮质激素治疗前后哮喘患儿血浆血小板活化因子(PAF)水平的变化的观察,进一步探讨其临床意义。方法:采用生物学检测法,检测哮喘急性发作期患儿血浆PAF浓度及吸入糖皮质激素治疗后血浆PAF浓度,并以同期体检健康儿童24例作为对照。结果:哮喘急性发作期患儿血浆PAF浓度吸入糖皮质激素治疗前较治疗后明显增高,差异有显著性(t=2.458,P<0.05),经吸入糖皮质激素治疗后患儿血浆PAF浓度降至正常水平,与对照组比较差异无显著性(t=1.527,P>0.05)。结论:PAF作为一种重要的继发性炎性介质,其生成和释放参与了哮喘患儿气道慢性炎症、高反应性和可逆性阻塞的形成。糖皮质激素抑制了磷脂酶A2的活性,从而抑制了PAF的生成与释放。     

长期吸入糖皮质激素对支气管哮喘患儿血清中IL-6，IL-8和TNF-α水平的影响

目的观察支气管哮喘患儿血清中IL-6、IL-8和TNF-α水平的变化并探讨支气管哮喘患儿在长期吸入糖皮质激素后对血清中IL-6、IL-8和TNF-α的影响。方法采用酶联免疫吸附（ELISA）的方法，分别检测62例哮喘患儿采用吸入糖皮质激素治疗前，治疗3、6、12个月后及30例正常对照儿童血清中IL-6、IL-8和TNF-α水平。结果哮喘患儿血清中IL-6、IL-8和TNF-α水平显著高于正常对照组。吸入糖皮质激素治疗3个月后哮喘患儿血清中IL-6、IL-8和TNF-α浓度与治疗前比较下降（P值均〈0．05）；治疗6个月和12个月后哮喘患儿血清中IL-6、IL-8和TNF-α浓度显著低于治疗前（P值均〈0．01），且治疗12个月后各个炎症指标与对照组相比无显著性差异（P〉0．05）。结论长期吸入糖皮质激素是治疗儿童支气管哮喘的重要手段，其治疗作用与下调血清中IL-6、IL-8和TNF-α水平有关。     

长期吸入糖皮质激素对支气管哮喘患儿血清中瘦素、IL-13和IL-8水平的影响

目的观察支气管患儿血清中瘦素、IL-13和IL-8水平的变化并探讨长期吸入糖皮质激素后对支气管哮喘患儿血清中瘦素、IL-13和IL-8的影响。方法采用酶联免疫吸附（ELISA）的方法,分别检测70例支气管哮喘患儿采用吸入糖皮质激素治疗前,治疗3、6、12个月后及60例正常对照儿童血清中IL-13和IL-8水平;采用放射免疫法检测血清中瘦素浓度。结果支气管哮喘患儿血清中瘦素、IL-13和IL-8水平显著高于正常对照组。吸入糖皮质激素治疗3个月后支气管哮喘患儿血清中瘦素、IL-13和IL-8浓度与治疗前比较下降（P均〈0.05）,治疗6个月和12个月后显著低于治疗前（P均〈0.01）,且治疗12个月后各个炎症指标与对照组相比无显著性差异（P〉0.05）。结论长期吸入糖皮质激素是治疗儿童支气管哮喘的重要手段,其治疗作用与下调血清中瘦素、IL-13和IL-8水平有关。     

自拟补脾益肾定喘汤在小儿哮喘缓解期的应用

目的探讨自拟补脾益肾定喘汤在小儿哮喘缓解期的应用。方法将188例小儿哮喘缓解期患儿随机分为治疗组98例和对照组90例。治疗组采用自拟补脾益肾定喘汤联合糖皮质激素吸入治疗;对照组仅采用糖皮质激素吸入治疗。治疗后观察2组临床疗效。结果治疗组总有效率为88.8%高于对照组的72.2%,差异有统计学意义（P〈0.05）。结论自拟补脾益肾定喘汤辅治小儿缓解期哮喘疗效显著,值得推广应用。     

自拟补脾益肾定喘汤在小儿哮喘缓解期的应用

目的 探讨自拟补脾益肾定喘汤在小儿哮喘缓解期的应用.方法 将188例小儿哮喘缓解期患儿随机分为治疗组98例和对照组90例.治疗组采用自拟补脾益肾定喘汤联合糖皮质激素吸入治疗;对照组仅采用糖皮质激素吸入治疗.治疗后观察2组临床疗效.结果 治疗组总有效率为88.8%高于对照组的72.2%,差异有统计学意义(P＜0.05).结论 自拟补脾益肾定喘汤辅治小儿缓解期哮喘疗效显著,值得推广应用.     

唾液皮质醇与血浆皮质醇、尿游离皮质醇测定的相关性分析及其临床价值

目的探讨正常人唾液皮质醇、血浆皮质醇和24 h尿游离皮质醇三者之间的相关性。方法选择30例健康受试者同时检测唾液皮质醇、血浆皮质醇和24 h尿游离皮质醇。男子组和女子组各15例。采用化学发光技术测定,唾液标本采用唾液收集器收集,血标本为血浆,24 h尿液标本用硼酸防腐。结果唾液皮质醇和血浆、24 h尿液皮质醇在正常男女组之间均无显著性差异（P＆gt;0.05）,唾液皮质醇与血浆皮质醇（r=0.91）、唾液皮质醇与24 h尿游离皮质醇（r=0.95）,均存在显著的相关性。结论唾液皮质醇可作为库欣氏综合征的筛查指标。     

吸入性糖皮质激素对哮喘患儿血清1,25-（OH）2D3、皮质醇及促肾上腺皮质激素水平的影响

目的:探讨吸入性糖皮质激素对哮喘患儿血清1,25-(OH)2D3、皮质醇及促肾上腺皮质激素水平的影响。方法:随机选取56例支气管哮喘患儿(其中轻度哮喘患儿30例,中度哮喘患儿26例),应用吸入性糖皮质激素进行治疗。5岁以下的哮喘患儿给予硫酸沙丁胺醇气雾剂每喷100μg,2喷/次,3次/天,丙酸氟替卡松气雾剂每喷125μg,1喷/次,3次/天,治疗时均加用储雾罐辅助,治疗1~2周,待症状控制后,停用硫酸沙丁胺醇,丙酸氟替卡松减量为2次/天;5岁以上的哮喘患儿使用布地奈德-福莫特罗吸入剂或沙美特罗-替卡松粉吸入剂2次/天,按照病情控制情况逐步减量。分别于治疗前及治疗后4、8、12个月采集静脉血2 m L,采用放射免疫法检测血清1,25-(OH)2D3、皮质醇及促肾上腺皮质激素水平。结果:治疗前及治疗后4、8、12个月患儿血清1,25-(OH)2D3、皮质醇及促肾上腺皮质激素水平均在正常范围内,无明显下降趋势,不同时间点比较差别无统计学意义(P>0.05)。结论:吸入性糖皮质激素对哮喘患儿骨骼的代谢、下丘脑-垂体-肾上腺轴功能无明显影响,在临床上长期应用吸入性糖皮质激素治疗儿童支气管哮喘是安全有效的。     

Topical and systemic glucocorticoid potencies of budesonide and beclomethasone dipropionate in man

Summary Topical anti-inflammatory (cutaneous “vasoconstriction”) and systemic glucocorticoid (depression of plasma cortisol and changes in differential WBC count) potencies of the two glucocorticoids budesonide and beclomethasone dipropionate (BDP) were compared in human volunteers. After topical application, budesonide was 2–3 times more potent than BDP in inducing “vasoconstriction”. After oral administration, on the other hand, budesonide was 2–4 times less potent than BDP in depressing plasma cortisol and changing the total or differential WBC. After inhalation, too, significant differences in favour of budesonide were noted, but the divergence between the drugs was less pronounced. The improved relationship between the topical and systemic glucocorticoid effects of budesonide makes it a promising alternative for aerosol treatment in asthma.     

Effect of fluocortin butylester and beclomethasone dipropionate on the adrenal gland in beagle dogs.

The effect of butyl-6 alpha-fluoro-11 beta-hydroxy-16 alpha-methyl-3,20-dioxo-1,4-pregnadien-21-oate (fluocortin butylester, Vaspit) administered intratracheally and of beclomethasone dipropionate given intratracheally or orally on the adrenal glands of beagle dogs was investigated. The adrenal function was evaluated using a standardized ACTH stimulation test including eosinophil counts 5 h after a single i.v. injection of 0.02mg (approximately 2 IU) ACTH/kg body weight were found as well as the histological and morphometrical examination of the adrenal cortex. The cortisol determination (with Clark's method) 1.5 h and eosinophil counts to be the optimum indices for the evaluation of adrenal function. Beclomethasone dipropionate given intratracheally at daily dose levels of 0.05; 0.1 and 0.5 mg/kg body weight lead to a dose dependent adrenal suppression on the basis of plasma cortisol concentration, eosinophil counts after ACTH stimulation and size of zona fasciculata and reticularis. A complete adrenal suppression was observed at the highest dose level of 0.5 mg/kg bw. Also the oral administration of 0.1 mg/kg bw./day of beclomethasone dipropionate had a definite adrenal suppressive effect comparable to that of 0.1 mg/kg bw. given intratracheally. However, intratracheal administration of fluocortin butylester even after a 320 times higher dose (2 X 8 mg/kg bw./day) had no suppressive effect on the adrenal gland of the beagle dog.     

The influence of a new corticosteroid, budesonide, on anaphylactic bronchoconstriction and SRS-A release in the guinea pig

Groups of guinea pigs sensitized with ovalbumin were treated with budesonide and beclomethasone dipropionate, respectively, in an intraperitoneal dose of 50 mg/kg. 20 h later, the anaphylactic release of histamine and slow reacting substance of anaphylaxis (SRS-A) from chopped lung tissue was studied. Whereas the corticosteroids studied had no effect on the tissue content of histamine or on the amount of antigen-induced release of this autacoid, budesonide and beclomethasone dipropionate to a great extent inhibited the release of SRS-A. The anti-anaphylactic effect of budesonide and beclomethasone was also shown in sensitized guinea pigs pretreated with mepyramine, 2.5 mg/kg intraperitoneally, and challenged with nebulized ovalbumin. We suggest that the partial protection given by the corticosteroids budesonide and beclomethasone dipropionate is due to the inhibiton of SRS-A release.     

Adrenal effects and pharmacokinetics of CFC-free beclomethasone dipropionate: a 14-day dose-response study.

Since equivalent efficacy is achieved with lower doses of the reformulated beclomethasone dipropionate in the chlorofluorocarbon (CFC)-free propellant HFA-134a (HFA) than with the original CFC-beclomethasone dipropionate formulation, it is possible the HFA-beclomethasone dipropionate may have less safety concerns than the CFC formulation. Despite its chronic use, the steady-state pharmacokinetics of beclomethasone dipropionate has never been studied before. This double-blind study examined adrenal effects and pharmacokinetics after 14 days of dosing with HFA-beclomethasone dipropionate. Forty-three steroid-naïve asthmatic patients were randomised into 5 parallel groups and dosed every 12 h for 14 days with: HFA-placebo; 200, 400 or 800 μg day_-1 HFA-beclomethasone dipropionate; or 800 μg day_-1 CFC-beclomethasone dipropionate. After two weeks of dosing, the 24-h urinary free cortisol of all but one patient remained within the normal range, showing that all doses were well tolerated from a systemic safety perspective. The active HFA-beclomethasone dipropionate treatment groups showed a dose-related fall in 24-h urinary free cortisol. Total-beclomethasone (beclomethasone dipropionate and metabolites) pharmacokinetics after either the first dose of HFA-beclomethasone dipropionate or CFC-beclomethasone dipropionate were not substantially affected by subsequent doses. The extent of drug absorption from 800 μg day_-1 HFA-beclomethasone dipropionate and CFC-beclomethasone dipropionate was in the ratio of 1–7: 1. A non-linear correlation between 24-h urinary free cortisol and the pharmacokinetic parameters was observed, reflecting smaller changes in 24-h urinary free cortisol than in pharmacokinetics as the dose was increased. No clinically meaningful change in the pharmacokinetics of beclomethasone dipropionate plus metabolites was seen on multiple dosing. The greater systemic availability of HFA-beclomethasone dipropionate was still associated with adrenal effects comparable with that of the CFC formulation at the same dose.     

Effect of intratracheal and oral application of corticosteroids on the adrenal function test in beagle dogs after ACTH-stimulation.

The effect of synthetic corticosteroids given intratracheally or orally on the adrenal glands of beagle dogs was investigated. The adrenal function was evaluated using a standardized ACTH stimulation test. In addition, histological and morphometrical examinations of the adrenal cortex were performed at the end of the study. Beclomethasone dipropionate given intratracheally at daily dose levels of 0.05, 0.1 and 0.5 mg/kg body weight led to a dose dependent adrenal suppression on the basis of plasma cortisol concentration and eosinophil counts after ACTH stimulation and size of zona fasciculata and reticularis. A complete adrenal suppression was observed at the highest dose level of 0.5 mg/kg body weight. Also the oral administration of 0.1 mg/kg body weight/day of beclomethasone dipropionate had a definite adrenal suppressive effect comparaable to that of 0.1 mg/kg body weight given intratracheally. However, intratracheal administration of fluocortin butylester, a local antiinflammatory drug but systemically a nearly ineffective corticosteroid (2 X 8 mg/kg body weight/day) had no suppressive effect on the adrenal gland of the beagle dog, even after a 320 times higher dose.     

Beclomethasone dipropionate inhaler: a review of its pharmacology, therapeutic value and adverse effects. I: Asthma.

Beclomethasone dipropionate is a topically active corticosteroid used as an adjuvant in the control of chronic asthma when given by inhalation as an aerosol. It is not intended for treatment of acute attacks. It appears that the main difference between beclomethasone dipropionate and other corticosteroids previously used by inhalation is its high topical activity together with a lower systemic activity due to metabolic inactivation of the swallowed portion of the dose. Clinical experience has shown that at doses of 200 to 600mug daily, beclomethasone dipropionate inhaler is preferable to oral corticosteroids, because of lack of side-effects, when adult patients and children who are inadequately controlled by full doses of sodium cromoglycate and bronchodilators, are first considered to need maintenance corticosteroids. Inhaled beclomethasone dipropionate can allow a worthwhile reduction in maintenance doses of systemic corticosteroids in many patients already receiving these drugs and can replace systemic steroids entirely in some patients, particularly when their initial dose of steroids is less than 10mg daily of prednisone or its equivalent. Substitution should be attempted when the patient's asthma is well controlled on their usual doses of systemic steroids and full doses of other adjuvant therapy. Withdrawal of systemic corticosteroids should be performed slowly and carefully. Because recovery from impaired adrenocortical function caused by prolonged systemic steroid therapy is usually slow, special care is necessary for 9 to 12 months after transfer to beclomethasone dipropionate aerosol until the hypothalamo-pituitary-adrenal axis has sufficiently recovered to cope with emergencies such as trauma, surgery, severe infections or an acute attack of asthma. It is essential that additional therapy including high doses of systemic corticosteroids be used immediately to control any acute exacerbation of asthma which occurs during maintenance therapy with beclomethasone dipropionate aerosol. Tests of adrenal function suggest that beclomethasone dipropionate at dosages of 400 to 800 mug daily has little or no adverse effect. The most common side-effect associated with the continuous use of beclomethasone dipropionate inhaler has been oropharyngeal candidiasis, which appears to be dose-related and more common in women than in men. Systemic steroid withdrawal effects, like being generally unwell, and exacerbation of underlying allergic diseases such as allergic rhinitis, have been reported after substitution of beclomethasone dipropionate inhaler for systemic steroids. However, systemic withdrawal effects seldom occur if systemic steroids are withdrawn slowly.     

布地奈德吸入治疗小儿急性感染性喉炎疗效观察

目的 探讨布地奈德吸入治疗小儿急性感染性喉炎疗效.方法 选取2010年1月至2012年1月收治的急性感染性喉炎168例,分为常规治疗组80例,布地奈德组88例观察两组临床疗效.结果 布地奈德组总有效率97.72 %,常规治疗组总有效率80.00 %,两组总有效率比较,有显著差异性(P<0.05).结论 布地奈德混悬液是临床上应用吸入糖皮质激素唯一品种,具有高度亲脂性,直接作用于气道,抑制变态反应、抗炎作用是氢化可的松的600倍,地塞米松的20～30倍,丙酸倍氯米松的2倍;可使微小血管收缩,炎症渗出减少,减轻水肿,清除呼吸道炎症;常规治疗剂量中不会产生全身不良反应,不会出现皮质醇增多症.总之,布地奈德吸入治疗小儿急性感染性喉炎疗效确切,应用方便,是治疗急性喉炎首选方法.     

Respiratory function on asthmatic patients using beclomethasone dipropionate administered by pressurised aerosol

Summary

Beclomethasone dipropionate has been used by inhalation from a pressurised aerosol by asthmatic patients. In 28 out of 39 patients, it was possible to discontinue oral steroids within 28 days. The length of the study varied from 6 weeks to 28 weeks with an average of 19 weeks. Once the patients had been taken off oral steroids, beclomethasone dipropionate provided the only form of corticosteroid therapy during the period of the study. Clinically, the steroid aerosol provided the expected benefits observed when oral corticosteroids are given to asthmatic patients. In each case there was a rise in plasma Cortisol level which was confirmed by tetracosactrin stimulation tests. This return of adrenal response supports the theory that inhaled beclomethasone dipropionate acts in a similar manner to oral corticosteroids, but does not exhibit the same systemic effect. Airways resistance and lung volumes remained within a constant band throughout the study in spite of complete withdrawal of oral steroids from 28 of the 39 patients. Eleven of the 39 patients had frequent fluctuations in airways resistance, but were, by the end of the study, receiving considerably reduced doses of oral steroids. Only 2 patients completed the study on a higher dose of oral steroids than that on which they entered.     

万托林联合布地奈德利用氧气雾化吸入治疗毛细支气管炎的疗效观察

目的评估万托林联合布地奈德利用氧气驱动雾化吸入治疗毛细支气管炎的治疗效果。方法随机分为两组,对照组单纯利用万托林高频雾化吸入,实验组利用万托林与布地奈德交替氧气雾化吸入,观察雾化后患儿喘憋、呼吸困难、肺部哮鸣音改变情况,患儿肺部干湿
音消失时间和住院天数。结果患儿在利用万托林与布地奈德交替氧气雾化吸入后,患儿喘憋、呼吸困难、肺部哮鸣音改变情况,患儿肺部干湿
音消失时间和住院天数经统计学分析,有显著意义(P<0.01)。结论利用万托林与布地奈德交替氧气雾化吸入治疗毛细支气管炎,效果显著。     

布地奈德雾化吸入治疗急性喉炎、急性喉气管支气管炎的疗效观察

目的：探讨布地奈德混悬液雾化吸入治疗急性喉炎、喉气管支气管炎的疗效。方法：65例急性喉炎、急性喉气管支气管炎患儿随机分两组．治疗组34例给予布地奈德雾化吸入,对照组31例给予地塞米松超声雾化治疗。结果：治疗组症状消失时间明显短于对照组：治疗组治愈率明显高于对照组。结论：布地奈德混悬液雾化吸入治疗急性喉炎、急性喉气管支气管炎有较好疗效。