吸入丙酸氟替卡松对支气管哮喘患者肾上腺功能影响的meta分析

目的 根据现有临床研究评价吸入丙酸氟替卡松(FP)对支气管哮喘(简称哮喘)患者肾上腺功能影响的剂量效应关系.方法 从1978-2007年MEDLINE光盘数据库和1978-2007年中国生物医学光盘数据库,检索哮喘患者吸入FP为研究对象、比较吸入FP 4周后.进行促肾上腺皮质素刺激实验的随机对照实验文献,对肾上腺功能影响的剂量-效应关系进行随机、安慰剂对照的meta分析.结果 有5项研究中的732例哮喘患者符合纳入标准,安慰剂组肾上腺功能低于正常值例数是3.9%,FP组增加至500 μg/d的剂量,肾上腺功能异常增加的比数比是1.38(95%的可信限为1.01～1.59);当FP逐渐增加至2 000 μg/d,与肾上腺功能异常呈线性关系.结论 常规应用FP 200～500 μg/d是安全的,对肾上腺功能的影响很小.     

布地奈德气雾剂与沙美特罗丙酸氟替卡松干粉剂治疗支气管哮喘疗效比较

目的观察比较布地奈德气雾剂以及沙美特罗丙酸氟替卡松干粉剂治疗支气管哮喘患者的临床疗效和不良反应。方法对2011年9月至2012年9月我院收治的80例支气管哮喘患者根据入院先后顺序,随机分为观察组和对照组,每组40例。观察组患者吸入布地奈德气雾剂治疗,每次吸入布地奈德200ug,2次／d;对照组患者吸入沙关特罗、丙酸氟替卡松干粉剂治疗,每次吸入沙美特罗50ug,丙酸替卡松100ug,2次／d,疗程3个月。对比分析两组的临床疗效和不良反应。结果布地奈德气雾剂治疗支气管哮喘的总有效率为95．0％,沙美特罗丙酸氟替卡松干粉剂治疗支气管哮喘的总有效率为92．5％,两组临床治疗效果以及不良反应发生率比较,差异均无统计学意义（P〉0．05）。结论布地奈德气雾剂与沙美特罗丙酸氟替卡松干粉剂治疗支气管哮喘均有较好的临床效果,且不良反应轻微,在临床上值得推荐使用。     

丙酸氟替卡松治疗哮喘预测指数阳性喘息婴幼儿的疗效观察

目的观察丙酸氟替卡松治疗哮喘预测指数阳性喘息婴幼儿的疗效。方法选择该院儿科门诊及住院诊断为哮喘预测指数阳性的喘息婴幼儿作为研究对象,共100例。按随机号码表法分为研究组50例和对照组50例,两组急性期均接受沙丁胺醇气雾剂吸入治疗。缓解期研究组接受丙酸氟替卡松预防治疗,对照组不接受丙酸氟替卡松治疗干预。对研究组和对照组3个月、6个月、9个月时喘息发生率、急诊/住院率进行比较。在两组患儿5岁时回访,计算两组患儿哮喘诊断率。结果 (1)研究组3个月、6个月、9个月喘息发生率、急诊/住院率分别为22%、12%、4%、6%,对照组分别为30%、20%、18%、24%,两组比较差异有统计学意义。研究组和对照组哮喘诊断率分别为16%和44%,差异有统计学意义。结论丙酸氟替卡松能明显减轻婴幼儿喘息发作程度,减少喘息发作次数。     

丙酸氟替卡松治疗哮喘患者的疗效评价

目的 评价短期使用新型吸入型糖皮质激素—丙酸氟替卡松的有效性和安全性。方法 50例未达到控制的支气管哮喘患接受6周的吸入丙酸氟替卡松治疗，于用药前后比较日、夜间症状评分，短效β2—受体激动剂按需使用次数，晨间、夜间PEF值及试验开始和结束时的FEVl值。结果 治疗后各项指标均有明显改善。在症状改善方面优于肺功能改善。肺功能指标的改善在中、重度哮喘患明显。上述剂量短期内使用安全可靠。结论 中等剂量的丙酸氟替卡松临床疗效显、安全性好是目前治疗哮喘的最佳的吸入激素制剂之一。     

沙美特罗氟替卡松对支气管哮喘患者血清IL-21和IgE水平的影响

目的探讨沙美特罗氟替卡松用于支气管哮喘治疗时对患者血清IL-21和Ig E水平的影响。方法采用沙美特罗氟替卡松吸入治疗78例支气管哮喘患者,同时选取45例健康体检人员作为对照组,分别检测支气管哮喘患者治疗前后及对照组人员血清IL-21及Ig E,并进行对比分析。结果 78例支气管哮喘患者总有效率为89.7%(70/78);支气管哮喘组血清IL-21及Ig E水平显著高于对照组(P0.01);治疗3个月后支气管哮喘组血清IL-21及Ig E显著降低(P0.01),但仍显著高于对照组(P0.01)。结论沙美特罗氟替卡松吸入治疗支气管哮喘能够有效降低血清IL-21及Ig E水平,减轻气道炎症反应,进而降低气道高反应性,疗效可靠。     

丙酸氟替卡松吸入治疗婴幼儿早期喘息68例临床分析

喘息是婴幼儿下呼吸道感染最常见的症状 ,在临床上对婴幼儿喘息的治疗无良好方法。婴幼儿喘息常由喘息性支气管炎、喘息婴儿综合征、喘息性下呼吸道病、喘息相关性呼吸道病、复发性毛细支气管炎和婴幼儿哮喘等引起[1] ,具有反复发作倾向 ,其中许多患儿发展成哮喘 ,因此对婴幼儿     

沙美特罗／丙酸氟替卡松对支气管哮喘患者转化生长因子β1／Smad通路的影响

目的观察沙美特罗／N酸氟替卡松对中重度持续支气管哮喘（简称哮喘）患者转化生长因子p1（transforminggrowthfactor—β1,TGF-β1）／Smad通路的影响。方法中重度持续哮喘患者30例,对照组20例。哮喘组给予规律吸入沙美特罗／N酸氟替卡松50／250／xg,2次／d,持续6个月。酶联免疫吸附试验（ELISA法）定量测血清TGF-β1、Smad2表达,宝石能谱高分辨率CT（HRCT）扫描测量气道壁厚度／气道外径（T／D）、气道壁面积占气道总面积百分比（WA％）评估气道重塑程度。结果哮喘组（治疗前）血清TGF-β1（301．5±27．3）ng／L、Smad2（1182．1±50．6）ng／L与对照组TGF—β1（55．2±12．8）ng／L、Smad2（796．4±56．2）ng／L比较差异有统计学意义（t=8．52,t=5．90,P值均〈0.05）,哮喘组（治疗后）TGF-β1,（96．1±25．6）ng／L、Smad2（853．4±49．7）ng／L与哮喘组（治疗前）比较差异具有统计学意义（t=7．21,t=3．13,P值均〈O．05）,哮喘组（治疗后）血清Smad2与对照组比较差异无统计学意义（t=0．24,P〉o．05）;哮喘组（治疗前）T／D（23．66士4．06）％较对照组（19．79士3．37）％增加,差异有统计学意义（t=3．45,P〈O．05）,哮喘组（治疗前）wA％（69．24±6．03）‰值与对照组（51．67±4．55）％比较差异有统计学意义（t=3．77,P〈O．05）。规律吸入沙美特罗／丙酸氟替卡松6个月后,哮喘组（治疗后）T／D（20,43±3．00）％、WA％（58．40±3．85）％下降,与哮喘组（冶疗前）比较差异有统计学意义（t=2．96,t=3．05．P值均〈0．05）,哮喘组（治疗后）T／D与对照组比较差异无统计学意义（t=0．95,P〉0．05）,气道重塑减轻。结论哮喘患者气道重塑伴随血TGF-β1、Smad2蛋白的表达增加,规律吸入沙美特罗j丙酸氟替卡松可以通过减少血清TGF-β1、Smad2蛋白的表达,从而减轻哮喘患者气道重塑。调节TGF-β1／Smad通路可能是治疗哮喘气道重塑的新策略。     

普仑司特联合丙酸氟替卡松治疗小儿哮喘的临床意义

目的分析普仑司特联合丙酸氟替卡松治疗小儿支气管哮喘的疗效。 方法选取2020年9月至2021年8月我院收治的小儿支气管哮喘患儿59例,随机分为对照组26例,给予雾化吸入丙酸氟替卡松吸入气雾剂治疗;观察组33例,给予普仑司特+丙酸氟替卡松治疗。对比两组患儿临床症状缓解时间、临床疗效、肺功能指标、嗜酸性粒细胞(EOS)及免疫球蛋白E(IgE)水平,及两组患儿不良反应。 结果观察组咳嗽消失、发热消退及肺部啰音消失时间均短于对照组(P<0.05)。两组患儿临床疗效分布差异显著(P<0.05),且观察组总有效率高于对照组(P<0.05)。治疗后两组患儿FEV₁、FVC、FEV₁/FVC及PEF均升高(P<0.05),且观察组FEV₁、FVC、FEV₁/FVC及PEF均高于对照组(P<0.05)。治疗后两组患儿EOS、IgE水平均降低(P<0.05),且观察组EOS、IgE水平均低于对照组(P<0.05)。 结论普仑司特联合丙酸氟替卡松治疗小儿支气管哮喘可缩短患儿临床症状改善时间、提高临床疗效,改善患儿肺功能,有效调节EOS、IgE水平。     

沙美特罗氟替卡松治疗哮喘的临床疗效及对肺功能的影响

目的探讨沙美特罗氟替卡松治疗哮喘的临床疗效及对肺功能的影响。方法将120例哮喘患者随机分为对照组与观察组,每组60例。给予观察组患者沙美特罗氟替卡松吸人,对照组患者接受沙丁胺醇吸人。比较两组临床治疗总有效率、日间哮喘症状评分及治疗前后肺功能的改变。结果观察组与对照组治疗总有效率分别为91．7％和78．3％,差别具有统计学意义（P〈0．05）;治疗后1月～3月,观察组患者日间哮喘症状评分显著低于对照组（P〈0．05）;治疗后3月观察组用力肺活量（FVC）、第一秒末用力呼气量（FEV1）实／预、最大呼气流速（PEF）和最大呼气中段流量（MMEF）显著优于对照组（P〈0．05）。结论沙美特罗氟替卡松治疗哮喘可显著提高临床疗效,改善患者肺功能及预后。     

吸入氟替卡松对支气管上皮肿瘤标志物的影响

背景和目的：香烟烟雾能导致支气管上皮发生一系列组织改变，最终发生恶变。吸入糖皮质激素能减少吸入香烟大鼠的肺部癌肿数量。本研究旨在观察吸入氟替卡松对吸烟者和接受根治性手术治疗的头、颈、肺部癌症患者癌前病变的作用。根据WHO的分类标准，观察经支气管镜活检的气管、中央支气管黏膜的癌前病变。对黏膜上皮化生发生率〉15％的研究对象采用随机接受氟替卡松干粉剂（500μg，每日2次）或安慰剂治疗，6个月后观察相同部位活检组织的上皮化生和不典型增生变化。     

Inhaled fluticasone propionate and adrenal effects in adult asthma: systematic review and meta-analysis.

The dose-response relationship of inhaled fluticasone propionate (FP) for adrenal suppression in adults with asthma is not clear. The current authors carried out a systematic review and meta-analysis of placebo-controlled randomised dose-response studies of >or=4 weeks' duration, which assessed the adrenal effects of FP by cosyntropin stimulation tests in adult asthma. The main outcome measure was the proportion of subjects with adrenal function below the lower limit of the normal range. Five studies, with a total of 732 subjects with asthma, met the inclusion criteria. Data on daily doses >1,000 mug were limited to one study. The proportion of subjects with adrenal function below the lower limit of the normal range on placebo was 3.9%; for a 500-microg per day increase in FP dose the odds of an abnormality increased by 1.38 (95% confidence interval 1.01-1.59). The continuous secondary outcome measures showed an inverse linear relationship with the FP dose up to 2,000 microg.day(-1). In conclusion, for routine prescribing within the established therapeutic dose-response range (50-500 microg.day(-1)), fluticasone propionate has minimal effects on adrenal function. This conclusion is limited by the paucity of long-term studies of daily doses of fluticasone propionate >1,000 mug and by the considerable individual variability in the response.     

Comparable efficacy of ciclesonide once daily versus fluticasone propionate twice daily in asthma

BACKGROUND: Inhaled corticosteroids are the mainstay of therapy in asthma, but local and systemic side effects and adherence remain a concern. Ciclesonide is an inhaled corticosteroid with on-site lung activation that provides potent anti-inflammatory activity and has been shown to have a good safety profile, even at high doses. OBJECTIVE: The aim of this study was to compare the efficacy and safety of once-daily ciclesonide versus twice-daily fluticasone propionate at comparable daily doses in patients with asthma. METHODS: In this multicenter, randomized, double-blind, double-dummy, parallel group study, 529 patients were randomized to ciclesonide 160 microg once daily or fluticasone propionate 88 microg twice daily for 12 weeks. The primary endpoint was change in lung function. RESULTS: Both ciclesonide and fluticasone propionate significantly improved forced expiratory volume in 1s, forced vital capacity, and morning peak expiratory flow compared with baseline (p<0.0001 for all variables). Both medications reduced asthma symptoms and rescue medication use within the first 24 h. At the tested dose, both medications were equally safe and well tolerated. CONCLUSION: Ciclesonide 160 microg once daily was as effective as fluticasone propionate 88 microg twice daily in improving lung function and asthma symptoms, and in reducing rescue medication use in patients with asthma.     

Efficacy and safety of low-dose fluticasone propionate compared with zafirlukast in patients with persistent asthma

To compare the efficacy and safety of fluticasone propionate and zafirlukast in patients with relatively stable persistent asthma who were previously treated with inhaled corticosteroids and short-acting beta(2)-agonists.A total of 440 patients (> or =12 years of age) previously treated with inhaled corticosteroids (beclomethasone dipropionate or triamcinolone acetonide) and short-acting beta(2)-agonists were included in this randomized double-blind study. After an 8-day run-in period, patients were treated with fluticasone (88 microg) or zafirlukast (20 mg) twice daily for 6 weeks. Outcome measures included pulmonary function (forced expiratory volume in 1 second [FEV(1)], peak expiratory flow [peak flow]), albuterol use, asthma symptoms, withdrawals due to lack of efficacy, and asthma exacerbations.Patients treated with fluticasone (n = 224) experienced greater mean increases in FEV(1) (0.24 L vs. 0.08 L, P <0.001), morning peak flow (30 L/min vs. 6 L/min, P <0.001), and evening peak flow (23 L/min vs. 5 L/min, P <0.001) during the study than did those treated with zafirlukast (n = 216). Fluticasone-treated patients had significantly greater increases in the mean percentages of symptom-free days (22% vs. 8%, P <0.001), rescue-free days (23% vs. 10%, P = 0.002), nights with uninterrupted sleep (<1% vs. -5%, P = 0.006), and fewer asthma exacerbations (1% vs. 6%, P = 0.005). Fewer fluticasone-treated patients were withdrawn due to lack of efficacy (2% vs. 13%, P <0.001).Inhaled fluticasone was more effective than zafirlukast in maintaining or improving asthma control in patients with relatively stable asthma who were switched from low-dose inhaled corticosteroids.     

Airway responsiveness to adenosine after a single dose of fluticasone propionate discriminates asthma from COPD

BackgroundRegular treatment with inhaled corticosteroids (ICS) is known to reduce airway hyperresponsiveness (AHR) to adenosine 5′-monophosphate (AMP) in asthma even after a single dose of fluticasone propionate (FP).AimTo determine whether this rapid protective effect of a single dose of FP is also present in COPD.Methods23 mild asthmatic and 24 COPD subjects with documented AHR to both AMP and methacholine took part in a randomized, double-blind, placebo-controlled, crossover study to measure AHR to inhaled AMP and methacholine 2 h after either 1000 μg FP or matched placebo.ResultsIn subjects with asthma, 1000 μg FP in a single dose significantly attenuated the constrictor response to AMP, geometric mean (range) PC20AMP values increasing from a 19.2 (1.3–116.3) to 81.5 (9.6–1600.0) (p < 0.001; post-placebo vs post-FP) mg/ml. Change in the airways response to inhaled AMP after FP was well within test variability in patients with COPD, with PC20AMP values 59.6 (11.3–183.9) and 76.3 (21.0–445.3) (p = 0.022; post-placebo vs post-FP) mg/ml. Additionally, FP failed to significantly attenuate the bronchial response to methacholine in both asthma and COPD subjects. A change in doubling dilution, between placebo and following a single dose of FP, in AMP had a better sensitivity and specificity of 95.8% and 65.2%, compared to methacholine of 79.2% and 43.5% respectively in delineating between COPD and asthma.ConclusionA single dose of 1000 μg FP rapidly improves AHR to AMP in asthmatics but not in COPD subjects. This may provide a convenient way by which provocation challenge with inhaled AMP may help in discriminating asthma from COPD.     

吸入丙酸氟替卡松加孟鲁司特预防毛细支气管炎后反复喘息疗效分析

目的对痊愈出院的毛细支气管炎患儿进行吸入丙酸氟替卡松加孟鲁司特治疗,观察该方法预防病后喘息再发作的疗效。方法前瞻性研究,将100例痊愈出院的毛细支气管炎患儿随机分成两组,治疗组和对照组,跟踪随访1年,观察并统计两组在观察期内喘息再发作的病例、发作次数及持续的时间。结果治疗组出现再发喘息病例数明显少于对照组,差异有统计学意义（P〈0.05）,且用药期间未见不良反应。结论吸入丙酸氟替卡松加孟鲁司特预防毛细支管炎后反复喘息疗效确切、不良反应小,可作为预防毛细支管炎后反复喘息的干预措施,值得临床推广。     

Comparison between compliance of fluticasone propionate diskhaler and of fluticasone propionate diskus in adult bronchial asthma patients

BACKGROUND AND OBJECTIVES: Because inhaled corticosteroids (ICS) play a central role in the management of asthma, new drug delivery systems for fluticasone propionate, Diskhaler (FPdh) and Diskus (FPdk), were developed. However, few studies have focused on compliance with these drug delivery systems, which can influence drug efficacy. Hence, we compared compliance with FPdk versus that with FPdh. METHODS: Data were obtained from a survey of pharmacists dispensing anti-asthmatic drugs to adult asthma patients who visited participating pharmacies between October 2002 and November 2003. Patients were limited to regular users of FPdh or FPdk whose medication had not been changed for >6 months before the survey. Compliance and daily administration frequency of ICS were evaluated on the basis of pharmaceutical records. Data on asthma status and various other factors affecting ICS compliance were obtained by questionnaire. RESULTS: Data were acquired on 337 patients. There were no significant differences in gender, age, and duration between the FPdk and FPdh groups. Although FPdk compliance was significantly higher than that of FPdh, conversely there was no significant difference in daily dose and administration frequency between the 2 groups. Furthermore, there was no significant difference in the rate of concomitant drug and in various influencing factors associated with drug compliance. Regarding compliance of concomitant drug, that of oral sustained-released theophylline was significantly lower in FPdk versus FPdh users. CONCLUSION: In the area of drug compliance, FPdk is superior to FPdh. Although the reason for this is unclear, it is probably due to the characteristics of FPdk itself.     

Short-term Treatment with a Low Dose of Inhaled Fluticasone Propionate Decreases the Number of CD1a+ Dendritic Cells in Asthmatic Airways

The activation of T-lymphocytes through the recognition of specific allergens is a crucial event in the development of allergic inflammation. Dendritic cells (DC) are potent accessory cells that play an important role in initiating bronchial immune responses by activation of T-lymphocytes. We investigated the distribution of CD1a+ DC in the bronchial biopsies from asthmatic patients, and evaluated the effects of a short course of low dose inhaled fluticasone propionate treatment. Twenty-three mild to moderate stable asthmatic patients and eight normal subjects were included in the study. Bronchoscopy with bronchial biopsies were performed in each subject. Eighteen of the 23 asthmatics underwent a second bronchoscopy after 6 weeks of low dose inhaled fluticasone propionate treatment (250 mcg bd) in a placebo-controlled double-blind study. Biopsies were embedded into glycolmethacrylate resin and analysed by immunohistochemistry methods using specific monoclonal antibodies against CD1a, which is a widely recognized marker for DC. In asthmatics, CD1a+ DC number was significantly higher in bronchial epithelium (P<0.001) and in lamina propria (P<0.001) when compared with normal controls. In addition, we observed that a short course of low dose inhaled fluticasone propionate treatment decreased the number of CD1a+ DC in both the bronchial epithelium (P<0.05) and lamina propria (P<0.01). The increased number of CD1a+ DC support the hypothesis that DC play an important role in the modulation of the immune response in chronic asthma. Short-term low dose fluticasone propionate treatment induces down-regulation of the CD1a+ DC number.