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。     

Improvement in Health Care Utilization and Pulmonary Function with Fluticasone Propionate in Patients with Steroid-Dependent Asthma at a National Asthma Referral Center

The impact of switching from other inhaled corticosteroids to fluticasone propionate was studied in patients with severe oral-steroid-dependent asthma over a 1-year period. In this open-label prospective study, patients on maintenance doses of oral and inhaled steroids were referred to a national asthma treatment center and were switched from their previous inhaled corticosteroid to fluticasone propionate 880 μg BID. Compared with data collected from the year prior to enrollment, treatment with fluticasone propionate resulted in significant improvements in pulmonary function, oral steroid requirements, and health resource utilization. In addition, five patients were completely weaned off oral steroids.     

Nebulized Fluticasone Propionate vs. Budesonide as Adjunctive Treatment in Children with Asthma Exacerbation

Objectives: To compare the effects of nebulized fluticasone propionate (FP) and nebulized budesonide (BUD) in addition to inhaled salbutamol in children with mild asthma exacerbation. Methods: The study was a multicenter, randomized, single-blind, parallel group design. One hundred and sixty-eight children, aged 4-15 years, were randomly allocated to receive either nebulized FP (250 mcg) or nebulized BUD (500 mcg) twice daily for 10 days. On presentation, at the end of treatment, and after a 7-day follow-up, clinical assessment and pulmonary function measurements were performed. Daytime and nighttime asthma symptom scores, the use of rescue salbutamol, and morning/evening peak expiratory flow (PEF) values were recorded at home during the treatment period. Morning cortisol concentration (51 children) and overnight urinary cortisol excretion (30 children) were also measured in six centers at the start and at the end of the treatment. Results: Improvement of morning PEF was significantly higher in patients treated with FP (p = 0.032). The percentage of symptom-free nights was significantly higher in the BUD group (p = 0.006), but no difference was found in symptom-free days. No intergroup difference was detected in the percentage of days/nights free from rescue medication and in pulmonary function tests performed in outpatient settings. There was no evidence of hypothalamo-pituitary-adrenal axis suppression. Conclusions: A short course of nebulized FP has the same effects as a double dose of nebulized BUD, when either drug is added to bronchodilator therapy in children with mild asthma exacerbation.     

Nebulized Fluticasone Propionate vs. Budesonide as Adjunctive Treatment in Children with Asthma Exacerbation

Objectives: To compare the effects of nebulized fluticasone propionate (FP) and nebulized budesonide (BUD) in addition to inhaled salbutamol in children with mild asthma exacerbation. Methods: The study was a multicenter, randomized, single-blind, parallel group design. One hundred and sixty-eight children, aged 4–15 years, were randomly allocated to receive either nebulized FP (250 mcg) or nebulized BUD (500 mcg) twice daily for 10 days. On presentation, at the end of treatment, and after a 7-day follow-up, clinical assessment and pulmonary function measurements were performed. Daytime and nighttime asthma symptom scores, the use of rescue salbutamol, and morning/evening peak expiratory flow (PEF) values were recorded at home during the treatment period. Morning cortisol concentration (51 children) and overnight urinary cortisol excretion (30 children) were also measured in six centers at the start and at the end of the treatment. Results: Improvement of morning PEF was significantly higher in patients treated with FP (p = 0.032). The percentage of symptom-free nights was significantly higher in the BUD group (p = 0.006), but no difference was found in symptom-free days. No intergroup difference was detected in the percentage of days/nights free from rescue medication and in pulmonary function tests performed in outpatient settings. There was no evidence of hypothalamo-pituitary-adrenal axis suppression. Conclusions: A short course of nebulized FP has the same effects as a double dose of nebulized BUD, when either drug is added to bronchodilator therapy in children with mild asthma exacerbation.     

Improved Ability to Perform Strenuous Activities After Treatment with Fluticasone Propionate/Salmeterol Combination in Patients with Persistent Asthma

Patients with asthma experience disruptions in usual activities that can impair their quality of life, and in patients whose daily routine involves an active lifestyle, these disruptions can be severe. We assessed the patient-perceived effect of treatment with fluticasone propionate/salmeterol combination (FSC), compared with fluticasone propionate (FP) or salmeterol (SAL) alone, on activity limitations, particularly strenuous physical activities. The Asthma Quality of Life Questionnaire (AQLQ) was administered in two 12-week, randomized, double-blind, placebo-controlled trials comparing FSC 100/50 or 250/50 µg twice daily vs. the individual components alone in 686 adults and adolescents with asthma. In one study, patients were stratified by prior treatment [low to medium doses of inhaled corticosteroids (ICS) or SAL], and in the other study, all patients were previously treated with medium to high doses of ICS. Patients prospectively identified five activities they performed regularly and were asked how these activities were limited by their asthma. The effect of randomized treatment on strenuous activities (e.g., aerobics, cycling, hiking, and basketball) was assessed. In both studies, treatment with FSC resulted in clinically meaningful improvements (i.e., change in AQLQ of ≥0.5) and was statistically significantly better than SAL in both studies and FP in one study. Treatment of the two main components of asthma—inflammation and bronchoconstriction—with FSC results in clinically meaningful improvements in the ability of patients with persistent asthma to perform not only their usual activities but also strenuous activities.     

Improved Ability to Perform Strenuous Activities After Treatment with Fluticasone Propionate/Salmeterol Combination in Patients with Persistent Asthma

Patients with asthma experience disruptions in usual activities that can impair their quality of life, and in patients whose daily routine involves an active lifestyle, these disruptions can be severe. We assessed the patient-perceived effect of treatment with fluticasone propionate/salmeterol combination (FSC), compared with fluticasone propionate (FP) or salmeterol (SAL) alone, on activity limitations, particularly strenuous physical activities. The Asthma Quality of Life Questionnaire (AQLQ) was administered in two 12-week, randomized, double-blind, placebo-controlled trials comparing FSC 100/50 or 250/50 µg twice daily vs. the individual components alone in 686 adults and adolescents with asthma. In one study, patients were stratified by prior treatment [low to medium doses of inhaled corticosteroids (ICS) or SAL], and in the other study, all patients were previously treated with medium to high doses of ICS. Patients prospectively identified five activities they performed regularly and were asked how these activities were limited by their asthma. The effect of randomized treatment on strenuous activities (e.g., aerobics, cycling, hiking, and basketball) was assessed. In both studies, treatment with FSC resulted in clinically meaningful improvements (i.e., change in AQLQ of ≥0.5) and was statistically significantly better than SAL in both studies and FP in one study. Treatment of the two main components of asthma—inflammation and bronchoconstriction—with FSC results in clinically meaningful improvements in the ability of patients with persistent asthma to perform not only their usual activities but also strenuous activities.     

Simultaneously Evaluating the Effects of One-week Fluticasone Propionate Inhalation Therapy on Lung Ventilation and Permeability in Children with Asthma

This study evaluated the effects of fluticasone propionate inhalation therapy on lung ventilation and alveolar permeability by quantitative Tc-99m DTPA radioaerosol inhalation lung scintigraphy in 15 children with asthma. Lung ventilation was evaluated as the distribution percentage (D%) of Tc-99m DTPA radioaerosols in the central, intermediate and peripheral regions of the right lung. Alveolar permeability was measured by the rate of Tc-99m DTPA radioaerosol clearance curve from the peripheral alveoli of the right lung and represented as slope. The D% and slopes were calculated before and after one-week inhalation therapy (100 µg fluticasone propionate two times daily for one-week) to evaluate the effects of inhalation therapy on lung ventilation and alveolar permeability. The preliminary results revealed statistically significantly improved lung ventilation but no significant change of alveolar permeability in the right lung after one-week fluticasone propionate inhalation therapy in children with asthma. We suggest that the widely available and noninvasive Tc-99m DTPA radioaerosol inhalation lung scintigraphy can simultaneously evaluate lung ventilation and alveolar permeability in one study and should contribute to any disorder involving both alveoli and airways.     

The Effects of One-Week Fluticasone Propionate Inhalation Therapy for Tc-99m DTPA Radioaerosol Distribution in Asthma of Children: A Preliminary Report

This study evaluated the effects of fluticasone propionate inhalation therapy for the distribution pattern of Tc-99m DTPA radioaerosols in 10 children with asthma. The homogeneous degree of depositing Tc-99m DTPA radioaerosol was evaluated using a modified standard score system over the bilateral lungs. The baseline scores were calculated from Tc-99m DTPA radioaerosol inhalation lung scintigraphy before inhalation therapy (100 µg fluticasone propionate two times daily for one week), and the scores were recalculated after inhalation therapy to evaluate the effects of one-week of fluticasone propionate inhalation therapy for Tc-99m DTPA radioaerosol distribution patterns. After one week of fluticasone propionate inhalation therapy, the scores were decreased in all of the 10 children, which may mean that the bronchial constriction degree due to asthma is decreased. In addition, there was a significantly statistical difference in the scores before and after one-week fluticasone propionate inhalation therapy (p < 0.05). In conclusion, one-week fluticasone propionate inhalation therapy could significantly improve the bronchial constriction due to asthma in children based on the evidence of Tc-99m DTPA radioaerosol inhalation lung scintigraphic findings.     

Short-Term Regular β2-Adrenergic Agonists Treatment Is Safe in Mild Asthmatics Taking Low Doses of Inhaled Steroids

Regular treatment with β₂ adrenergic agonists is controversial in bronchial asthma. To investigate whether β₂-adrenergic agonists can be used safely if associated with low doses of inhaled steroids, for a short period, without a deterioration of asthma control, we have examined 24 mild asthmatics. In a parallel, double-blind, placebo-controlled study, 1 week of run-in and run-out period framed 3 weeks of treatment. All patients received inhaled beclometha-sone dipropionate (BDP 250 μg t.i.d.); after 1 week, 12 patients inhaled 400 μg of broxaterol and 12 patients received placebo t.i.d. FVC, FEV₁, PD₂₀-FEV₁ methacholine, morning and evening PEF, and PEF amplitude % mean were measured before, during, and after treatment. No significant changes were noted in patients receiving inhaled broxaterol. There were no differences in symptoms and the use of rescue medication (salbutamol spray). We conclude that short-term regular treatment with (β₂-adrenergic agonists is not associated with a deterioration in asthma control in mild asthmatics inhaling low doses of steroids.     

吸入沙美特罗/氟替卡松或福莫特罗/布地奈德对支气管哮喘慢性持续期的疗效评价

目的 观察吸入沙美特罗/氟替卡松和福莫特罗/布地奈德对支气管哮喘慢性持续期的疗效.方法 将120例中度支气管哮喘慢性持续期的患者随机分为两组,一组吸入沙美特罗/氟替卡松(50/250),250 μg/次,2次/d,另一组吸入福莫特罗/布地奈德,(4.5/160),160 μg/次,2次/d.评价3个月、6个月内的急性发作次数、夜间发作次数、使用短效β2受体激动剂的次数和哮喘控制调查表评分.结果 治疗3月的沙美特罗组急性发作次数、使用短效β2受体激动剂的次数和哮喘控制调查表评分多于布地奈德组,夜间发作次数少于布地奈德组,但差异没有统计学意义;治疗6月时沙美特罗组急性发作次数、夜间发作次数、使用短效β2受体激动剂的次数和哮喘控制调查表评分均少于布地奈德组,但差异仍没有统计学意义.结论 中度支气管哮喘慢性持续期的患者吸入沙美特罗/氟替卡松或福莫特罗/布地奈德干粉剂均能取得同样的哮喘控制.     

沙美特罗替卡松联合脱敏疗法治疗过敏性支气管哮喘的临床疗效

目的探究沙美特罗替卡松联合脱敏疗法治疗过敏性支气管哮喘的临床疗效。方法选取广西医科大学第三附属医院2012—2013年收治的85例过敏性支气管哮喘患者,根据治疗方法不同分为观察组45例与对照组40例。两组患者均给予常规治疗,对照组患者在此基础上采用沙美特罗替卡松治疗,观察组患者在对照组基础上联合脱敏疗法治疗。比较两组患者的临床疗效,治疗半年及1年后肺功能指标〔第一秒用力呼气容积(FEV1)、峰值呼气流速(PEF)、一秒率(FEV1/FVC)〕、哮喘控制问卷(ACQ)评分、日间/夜间症状评分及每日用药计分,并观察两组患者不良反应发生情况。结果观察组患者临床疗效优于对照组(u=-2.234,P=0.025)。治疗半年及1年后观察组患者FEV1、PEF、FEV1/FVC高于对照组,ACQ评分、日间症状评分、夜间症状评分及每日用药计分低于对照组(P0.05)。观察组患者不良反应发生率为6.7%,低于对照组的25.0%(P0.05)。结论沙美特罗替卡松联合脱敏疗法治疗过敏性支气管哮喘的临床疗效确切,能有效改善患者肺功能,且不良反应发生率较低。     

Serum Level of Selenium,IL-4, IL-10 & IFN-g in Patients with Allergic Asthma,Allergic Rhinitis and Healthy Controls

Background: Allergic diseases have increased during the past decade worldwide. Th2 type lymphocyte response is known to play an important role in the process of allergic inflammation. IL-4, a mediator of type II cytokine response increases IgE synthesis and Interferon gamma, a cytokine of type I response interferes with IL-4 and inhibits IgE production. Selenium is an essential component of glutathione peroxides and changes in its plasma level has been proposed to be associated with allergic diseases. Materials and Methods: This study comprised of 21 cases of allergic asthma (AA), 33 cases of allergic rhinitis (AR) whose age and sex were matched with 28 healthy controls. IL-4, IL-10, IFN-g levels were tested by ELISA assay, and serum selenium was measured by atomic absorption spectorphotometery method. Results: Mean serum selenium level of AA and AR groups were lower than controls. Mean serum IL-4 level of AA was higher than the AR group. Mean serum IL-4 level of AA and AR group were higher than controls. Conclusion: The results of this study indicate that low selenium level may have a role in the pathogenesis of allergic diseases.     

Effects of Salmeterol and Fluticasone Propionate Combination versus Fluticasone Propionate on Airway Function and Eosinophilic Inflammation in Mild Asthma

BackgroundSalmeterol and fluticasone propionate combination (SFC) provides better asthma control than fluticasone propionate (FP) alone, however, little is known on the effects of differential treatments on airway function and inflammation in patients with mild asthma.MethodsWe randomized 27 mild persistent asthma patients treated with the equivalent of 400 μg beclomethasone dipropionate to receive SFC (50/100 μg, 13 patients) or FP (100 μg, 14 patients) twice daily for 8 weeks. We compared the effects of SFC and FP on pulmonary function assessed by spirometry and impulse oscillometry (IOS), eosinophil percentage of induced sputum and serum, and with asthma symptoms and control after each treatment.ResultsWe observed that SFC significantly improved forced expiratory volume in one second (p < 0.05), IOS measurements of total resistance R5 (p < 0.01), central resistance R20 (p < 0.05), and distal reactance X5 (p < 0.01) compared with FP. The percentage of eosinophils in sputum, but not in serum, decreased significantly more in the SFC group than in the FP group (p < 0.05). There was also a significant improvement in symptom control in the SFC group (p < 0.05).ConclusionsThese findings suggest that SFC is more useful than FP in mild asthma cases. The clinical benefit of SFC provides evidence that IOS and induced sputum allows for the detection of changes in airway function and inflammation.     

儿童过敏性鼻炎与支气管哮喘

很久以来一直认为儿童过敏性鼻炎与哮喘具有相关性。新近的流行病学研究证明,上、下呼吸道之间确实存在相互联系。而且,有多个学说解释过敏性鼻炎与哮喘的关系,两者具有相似的免疫学机制和病理生理学基础。越来越多的证据表明,过敏性鼻炎与哮喘具有共同的发病因素,且经常在同一个患者中并存,因此在制定治疗策略时应考虑完整气道的概念。     

Asthma in pregnancy

Worldwide the prevalence of asthma among pregnant women is on the rise, and pregnancy leads to a worsening of asthma for many women. This article examines the changes in asthma that may occur during pregnancy, with particular reference to asthma exacerbations. Asthma affects not only the mother but the baby as well, with potential complications including low birth weight, preterm delivery, perinatal mortality, and preeclampsia. Barriers to effective asthma management and opportunities for optimized care and treatment are discussed, and a summary of the clinical guidelines for the management of asthma during pregnancy is presented.     

Asthma and Allergic Rhinitis at 4 Years of Age in Relation to Fish Consumption in Infancy

It has been suggested that consumption of fish and polyunsaturated fatty acids could have a protective effect against inflammation in the airways and the development of asthma and other allergic diseases. Our objective was to test the hypothesis that fish consumption during the first year of life decreases the risk of childhood asthma and allergic rhinitis. We assessed the relation between introduction of fish in the diet during the first year of life and risk of asthma and allergic rhinitis in a prospective 4-year cohort study of 2531 Norwegian children. We estimated odds ratios (OR) in logistic regression analysis adjusting for potential confounders. A total of 47.6% children had fish during the first year of life. The adjusted OR for allergic rhinitis was 0.45 (95% confidence interval [CI] = 0.28, 0.74) and for asthma 0.84 (95% CI = 0.57, 1.22). Fish consumption in the first year of life may reduce the risk of developing asthma and allergic rhinitis in childhood.     

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。     

Treatment of Allergic Rhinitis as a Strategy for Preventing Asthma

Purpose of Review

To evaluate the impact of allergic rhinitis (AR) on the development of asthma and to update readers on recent literature suggesting that early treatment of allergic subjects with immunotherapy may prevent asthma onset.

Recent Findings

AR is frequently associated with asthma, leading to the concept that these two conditions are different aspects of the same disease. There is increasing evidence that AR precedes the onset of asthmatic symptoms and current treatment strategies are beneficial in symptom control with no impact prevention. There is limited knowledge about the risk factors responsible for the progression of AR to asthma, though recent data supports the notion that it is possible to prevent asthma onset by allergen immunotherapy.

Summary

Despite significant advances in specific immunotherapy (SIT) therapy strengthening its efficacy in AR and possible prevention of progression to asthma, the adoption of this therapeutic strategy is still restricted in comparison to therapies directed towards treatment of AR symptoms. Unlike corticosteroids and other symptomatic therapies, the benefit of SIT treatment in allergic individuals has been shown to prevent the development of allergic conditions. Hence, large well-conducted randomized clinical trials with long-term efficacy of SIT are required to confirm or refute the concept that SIT may abrogate the progression of AR to asthma in patients.