雾化吸入布地奈德混悬液在AECOPD的作用

目的以随机、对照试验比较雾化吸入布地奈德混悬液和口服泼尼松龙对AECOPD的作用。方法实验分3组，布地奈德组给予布地奈德雾化液4mg，雾化吸入，每12h1次；泼尼松龙组给予泼尼松龙片20mg，口服，每天2次，7d后减为10mg口服，每天2次；对照组不使用任何糖皮质激素。观察期为24、48h,7d和14d。结果布地奈德组、泼尼松龙组与对照组比较，FEV1、PaO2、PaCO2、pH改善值具有显著性差异（P〈0．05）；布地奈德组、泼尼松龙组两组各项指标改善程度相似（P〉0．05），但布地奈德组副作用明显低于泼尼松龙组（P〈0．05）。结论雾化吸入布地奈德混悬液可有效改善AECOPD的气流受限，疗效与口服泼尼松龙相似，全身副作用小，可作为皮质激素治疗的另一选择。     

雾化吸入不同浓度布地奈德联合复方异丙托溴铵溶液治疗慢性阻塞性肺疾病急性加重患者的疗效

目的观察不同浓度的糖皮质激素联合复方异丙托溴铵溶液对于慢性阻塞性肺疾病急性加重(AECOPD)患者的治疗效果。方法84例AECOPD患者随机分为大剂量布地奈德组及低剂量布地奈德组各42例。两组常规治疗的基础上,同时加用不同剂量布地奈德联合复方异丙托溴铵溶液,比较治疗前后临床症状评分、氧分压(PaO2)、二氧化碳分压(PaCO2)、FEV1%及FEV1/FVC,同时注意观察治疗过程中可能出现的各种不良反应。结果治疗前两组临床症状评分、PaO2及PaCO2差异无统计学意义(P>0.05),治疗后两组临床症状评分及PaCO2均降低,PaO2均升高(t=-30.654,15.913,13.873,P<0.05);治疗后,两组FEV1%及FEV1/FVC均改善,其中大剂量组肺功能改善显著(t=2.721,6.374,P<0.05)。结论大剂量布地奈德联合复方异丙托溴铵溶液联合雾化吸入能够显著改善AECOPD患者的临床症状及肺功能,并且安全有效。     

脾多肽联合布地奈德雾化吸入对COPD急性加重期患者肺功能及动脉血气指标的影响

目的研究脾多肽联合布地奈德雾化吸入对慢性阻塞性肺疾病急性加重期(AECOPD)患者肺功能及动脉血气指标的影响。方法 AECOPD患者84例随机分组,各42例。对照组予以布地奈德雾化吸入治疗,观察组予以脾多肽+布地奈德雾化吸入治疗。比较两组临床疗效,治疗前后用力肺活量(FVC)、1 s用力呼气容积(FEV1)、FEV1/FVC及动脉二氧化碳分压(PaCO_2)、动脉血氧分压(PaO_2)]变化。结果观察组临床治疗总有效率92.86%高于对照组71.43%(P0.05);治疗后观察组FVC、FEV1、FEV1/FVC高于对照组(P0.05);PaCO_2低于对照组、Pa O_2高于对照组(P0.05)。结论联合脾多肽和布地奈德雾化吸入用于AECOPD患者,可改善肺功能及动脉血气指标,疗效显著。     

布地奈德及特布他林联合噻托溴铵对老年慢性阻塞性肺疾病急性加重期患者肺功能的影响

目的探讨布地奈德及特布他林联合噻托溴铵对老年慢性阻塞性肺疾病急性加重期(AECOPD)患者肺功能的影响。方法2017年1月至2018年3月就诊的114例老年AECOPD患者采用随机数字表法分为对照组和观察组各57例。A组在常规措施的基础上给予布地奈德联合特布他林雾化吸入,B组在A组的基础上给予噻托溴铵吸入治疗。观察两组治疗前后1 s用力呼气量(FEV1)、FEV1占用力肺活量(FVC)的百分比、C反应蛋白(CRP)、白细胞计数、中性粒细胞计数、呼吸困难评分(MMRC)、动脉血氧分压(PaO2)和动脉血二氧化碳分压(PaCO2)。结果治疗后,两组FEV1、FEV1/FVC、PaO2水平显著高于治疗前,且观察组FEV1、FEV1/FVC、PaO2水平显著高于对照组(均P<0.05)。治疗后,两组CRP、白细胞计数、中性粒细胞比例、MMRC、PaCO2水平显著低于治疗前,且观察组CRP、白细胞计数、中性粒细胞比例、MMRC、PaCO2水平显著低于对照组(均P<0.05)。结论布地奈德及特布他林联合噻托溴铵治疗老年AECOPD可改善肺功能。     

布地奈德雾化吸人治疗慢性阻塞性肺病急性加重期的疗效分析（附35例报告）

目的观察布地奈德雾化吸入治疗慢性阻塞性肺病急性加重期（AECOPD）的疗效。方法将67例患者随机分为治疗组35例和对照组32例,2组患者均接受吸氧、抗感染、化痰、雾化吸入沙丁胺醇等常规治疗,治疗组于常规治疗基础上加用布地奈德雾化吸入,比较两组间的疗效。结果治疗组和对照组治疗后FEV1、PaO2、PaCO2较治疗前改善,两者差异有统计学意义（P〈0．05）;而治疗组治疗后FEV1、PaO2、PaCO2较对照组改善更明显,两者差异有统计学意义（P〈0．05）。结论布地奈德雾化吸入治疗AECO—PD,能改善肺功能和血气,疗效较好。     

雾化吸入与全身应用糖皮质激素在AECOPD中的临床研究

目的观察糖皮质激素雾化吸入对比全身治疗慢性阻塞性肺病急性加重期（AECOPD）的疗效、不良反应和经济成本。方法 70例中AECOPD患者随机分为雾化吸入组（34例）和全身应用组（38例）,分别给予布地奈德混悬液雾化吸入3mg/d（1mg/次,次/8h）,后改为2mg/d（1mg/次,次/12h）共15d;和甲泼尼龙静滴第1～3d,40mg/d,第4d开始口服泼尼松30mg/d,然后每3d减10mg,减至10mg后每3d减5mg至停药,共15d。记录治疗前和治疗15d后动脉血气PaO2和PaCO2;FEV1、FEV1/FVC,及药物的不良反应和经济成本。结果治疗后15d FEV1、FEV1/FVC雾化吸入组和静脉应用组分别上升了6.72%和8.30%（P〈0.05）,PaO2分别上升7.0mmHg和8.0mmHg,PaCO2分别下降7.3mmHg和8.1mmHg两组比较均有统计学意义（P〈0.05）。短期不良反应雾化吸入组主要为声嘶,全身应用组为血糖升高及消化道出血。两组患者住院时间,成本费用差异均无统计学意义。结论布地奈德雾化吸入治疗AECOPD与全身应用甲泼尼龙疗效一致,全身不良反应轻,短期治疗费用无明显增加。     

诱导痰中白介素-8和白介素-10与高原慢性阻塞性肺疾病急性加重期合并慢性肺心病发病的关系及其干预的研究

目的探讨诱导痰中白介素-8(IL-8)和IL-10与高原慢性阻塞性肺疾病急性加重期(AECOPD)合并慢性肺心病(CCP)患者发病的关系,评价吸入糖皮质激素(ICS)联合长效β2-激动剂(LABA)对其的干预作用。方法 132例高原AECOPD合并CCP患者随机分为3组,每组44例。3组的常规治疗(抗感染、祛痰、茶碱)相同。治疗2组给予沙美特罗/氟替卡松50μg/250μg,2次/d气道吸入;治疗1组给予布地奈德1mg,2次/d雾化吸入;对照组仅给予常规治疗。治疗前和治疗缓解2周后测定诱导痰中IL-8、IL-10浓度、FEV1%pred、FEV1/FVC、PaO2、PaCO2,观察各组治疗前后IL-8、IL-10浓度变化、肺功能和动脉血气改善程度。结果治疗前各组间诱导痰中IL-8、IL-10、FEV1%pred、FEV1/FVC、PaO2、PaCO2无统计学差异(P>0.05);治疗后各组诱导痰中IL-8、IL-10、FEV1%pred、FEV1/FVC、PaO2、PaCO2与治疗前比较均有非常显著性差异(P<0.01),治疗后各组间比较也有显著性差异(P<0.01或P<0.05)。132例患者治疗前,诱导痰中IL-8与FEV1%pred、FEV1/FVC、PaO2显著负相关(分别r=-0.714、-0.597、-0.682,P<0.001),与PaCO2显著正相关(r=0.662,P<0.001);IL-10与FEV1%pred、FEV1/FVC、PaO2显著正相关(分别r=0.653、0.631、0.656,P<0.001),与PaCO2显著负相关(r=-0.543,P<0.001)。结论 IL-8、IL-10参与了高原AECOPD合并CCP患者的气道炎症过程,ICS可降低气道内IL-8水平、升高IL-10水平,ICS联合LABA治疗高原AECOPD合并CCP的疗效优于单一ICS。     

布地奈德联合特布他林雾化吸入治疗慢性阻塞性肺疾病急性加重期的疗效研究

目的探讨布地奈德(普米克令舒)联合特布他林(博利康尼)雾化吸入治疗慢性阻塞性肺疾病急性加重期(AECOPD)的疗效。方法选取我院2010年1月—2013年6月住院的AECOPD患者60例,将其随机分为观察组和对照组,各30例。在常规治疗基础上观察组用普米克令舒+博利康尼混合后雾化吸入,对照组用0.9%氯化钠溶液+庆大霉素注射液+α-糜蛋白酶+地塞米松雾化吸入,均治疗10 d。治疗前后对两组患者进行肺功能检查及动脉血气分析。结果治疗后,观察组第1秒用力呼气容积(FEV1)、用力肺活量(FVC)及FEV1/FVC均高于对照组(P0.05);喘息缓解时间、咳嗽消失时间及哮鸣音基本消失时间均短于对照组(P0.05);PaO2高于对照组,PaCO2低于对照组(P0.05)。结论普米克令舒与博利康尼联合使用能明显改善AECOPD患者肺功能、血气指标及临床症状,且安全性高,可作为AECOPD的常规治疗方法。     

氧气驱动喷射式雾化吸入布地奈德在慢性阻塞性肺疾病急性加重期治疗中的作用

目的 研究氧气驱动喷射式雾化吸入糖皮质激素(布地奈德)在慢性阻塞性肺疾病急性加重期(AECOPD)中的治疗作用及临床应用价值. 方法 选择60例AECOPD住院患者作为研究对象,随机分为布地奈德组、甲基泼尼松龙组和对照组,对照组正规使用沙丁胺醇、特布他林、异丙托溴铵、抗生素等,布地奈德组和甲基泼尼松龙组在此治疗基础上分别联用PARI雾化泵吸入布地奈德或静脉滴注甲基泼尼松龙治疗,3组均同时进行肺功能和动脉血气分析的监测. 结果 布地奈德组、甲基泼尼松龙组治疗24 h、72 h及7 d后,第1秒用力呼气容积占预计值百分和动脉血氧分压均较对照组显著改善,差异有统计学意义(P＜0.05);且布地奈德组、甲基泼尼松龙组间比较无显著差异. 结论 PARI雾化泵吸入布地奈德可以替代静脉滴注甲基泼尼松龙治疗AECOPD.     

两药联合雾化吸入治疗AECOPD临床疗效观察

目的观察复方异丙托溴胺溶液联合布地奈德混悬液雾化治疗AECOPD的疗效。方法将70例AECOPD患者随机分为治疗组(n=35例)和对照组(n=35例)。治疗组在常规治疗基础上加用复方异丙托溴胺溶液2.5 ml(含异丙托溴胺0.5 mg沙丁胺醇3.0 mg)联合布地奈德混悬液2 ml(含布地奈德1 mg)进行高流量氧气驱动雾化吸入(即射流式雾化吸入);对照组为常规治疗方案。对两组治疗前后FEV1、FEV1/FVC、FEV1占预计值百分比及临床症状改善情况进行比较。结果治疗组患者在治疗期肺功能有明显改善,随着使用时间延长,肺功能改善持续提高。对照组患者治疗初期临床症状、肺功能有所改善,随着使用时间延长,肺功能改善不明显。结论复方异丙托溴胺溶液联合布地奈德混悬液雾化吸入治疗AECOPD疗效肯定。     

Gemcitabine,cisplatin and methylprednisolone chemotherapy (GEM-P) is an effective regimen in patients with poor prognostic primary progressive or multiply relapsed Hodgkin's and non-Hodgkin's lymphoma

This study was designed to assess the efficacy and safety of gemcitabine, cisplatin and methylprednisolone (GEM-P) for patients with relapsed or refractory Hodgkin's disease (HD) and non-Hodgkin's lymphoma. Twenty-one patients were treated with gemcitabine (1000 mg/m2 d 1, 8 and 15), cisplatin (100 mg/m2 d 15) and methylprednisolone (1000 mg d 1-5) given every 28 d. Of these, 20 patients were evaluable for response. The median age was 38 years (range 17-64 years). Histological subtypes were: nodular sclerosing HD (n = 10), diffuse large B cell (n = 5), T cell-rich B cell (n = 2), follicular (n = 2), mantle cell (n = 1) and enteropathy-associated T-cell lymphoma (n = 1). The median remission duration prior to receiving GEM-P was only 42 d. The overall objective response rate was 80%[95% confidence interval (CI): 56-94%], including five complete and 11 partial responses. GEM-P induced responses in all histological subtypes, primary progressive disease and patients who had received a previous autograft. The only grade 3-4 toxicity was myelosuppression. However, no cases of febrile neutropenia or haemorrhage with thrombocytopenia were encountered. Median survival has not yet been reached and survival probability at 1 year was 60.8% (95% CI: 31.9-80.5%). In conclusion, GEM-P is a novel combination salvage therapy for poor-prognostic primary progressive or multiply relapsed lymphoma patients. It has clinically significant activity with a favourable toxicity profile.     

c-Jun氨基末端激酶磷酸化在支气管哮喘大鼠气道重塑中的作用及糖皮质激素的影响

目的 研究c-Jun氨基末端激酶(JNK)磷酸化在支气管哮喘(简称哮喘)气道重塑中的作用,探讨糖皮质激素对白细胞介素(IL)-1β、JNK及哮喘气道重塑的影响.方法 将48只SD大鼠按随机数字表法分为对照组、哮喘组、布地奈德组和地塞米松组,每组12只,实验组以卵清白蛋白致敏和激发复制哮喘气道重塑模型,干预组分别于每次雾化激发前以布地奈德雾化或地塞米松腹腔注射干预,对照组以生理盐水代替卵清白蛋白致敏和激发.采用图像分析技术测定支气管壁厚度(Wat)和平滑肌厚度(Wam),ELISA法测定血清、BALF中IL-1β浓度,免疫组织化学检测肺内磷酸化JNK(P-JNK)及其下游物磷酸化c-Jun蛋白表达,Western blot检测肺匀浆P-JNK表达,直线相关分析Wat、Warn与P-JNK蛋白的平均吸光度(mA)的相关性以及P-JNK蛋白的mA与血清、BALF IL-1β浓度的相关性.结果 哮喘组气道壁厚度较对照组明显增加,其血清和BALF中IL-1β浓度[分别为(81±4)ng/L、(331±15)ns/L]高于对照组[(53±6)ng/L、(130±9)ns/L](t值分别为-8.62、-24.10,均P<0.01);免疫组织化学显示哮喘组P-JNK和P-c-Jun蛋白表达增高;Western blot检测哮喘组P-JNK蛋白的mA为1.66±0.16高于对照组的1.00±0.00(t=-8.35,P<0.01);布地奈德、地塞米松均可抑制JNK的磷酸化;各组Wat、Waln与P-JNK mA均呈高度正相关(r值分别为0.700、0.769,均P<0.01,rg=48),P-JNK的mA与血清、BALF IL-1β浓度均呈显著正相关(r值分别为0.689、0.805,均P<0.01).结论 JNK磷酸化与哮喘气道重塑密切相关;糖皮质激素能抑制JNK磷酸化,其机制之一可能是下调IL-1β表达.     

α,β-amyrin,a natural triterpenoid ameliorates L-arginine-induced acute pancreatitis in rats

AIM: To study the benef icial effects of triterpene α,β-amyrin and the underlying mechanisms in an experimental pancreatitis model. METHODS: Acute pancreatitis was induced in five groups of rats (n = 8) by L-arginine (2 × 2.5 g/kg, intraperitoneal, 1 h apart) and 1 h later, they received a single oral dose of α,β-amyrin (10, 30 and 100 mg/kg),methylprednisolone (30 mg/kg) and vehicle (3% Tween 80). A saline (0.9% NaCl) treated group served as a normal control. Efficacy was assessed at 24 h by determination ...     

Effects of once-daily formoterol and budesonide given alone or in combination on surrogate inflammatory markers in asthmatic adults

OBJECTIVES: We wished to evaluate the effects of once-daily combination therapy on surrogate inflammatory markers. METHODS: Fifteen patients with atopic persistent asthma were evaluated (mean age, 32.4 years; FEV(1), 75.2% predicted) in a randomized, double-blind, double-dummy, placebo-controlled crossover study with a 1-week placebo washout period, comparing the following once-daily nighttime treatments: (1) formoterol (FM), 12 microg, for 2 weeks and FM, 24 microg, for 2 weeks; or (2) budesonide (BUD), 400 microg, for 2 weeks and BUD, 800 microg, for 2 weeks; or (3) FM, 12 microg, plus BUD, 400 microg, for 2 weeks and FM, 24 microg, plus BUD, 800 microg, for 2 weeks. Adenosine monophosphate (AMP) bronchial challenge, exhaled nitric oxide (NO), and serum eosinophilic cationic protein (ECP) were evaluated at 12 h postdosing after administration of each placebo and after 2 and 4 weeks of each treatment. RESULTS: The results of AMP challenge (provocative concentration causing a 20% fall in FEV(1)) at 4 weeks showed significant (p<0.05) improvements after patients had received all active treatments compared to placebo (20 mg/mL), with FM plus BUD, 261 mg/mL, being superior (p<0.05) to FM alone, 82 mg/mL, but not to BUD, 201 mg/mL. NO and ECP showed significant (p<0.05) reductions compared to placebo with FM plus BUD or BUD alone but not with FM alone. Combination therapy was associated with optimal patient preference (rank order, FM plus BUD > FM > BUD; p<0.0005), highest domiciliary peak expiratory flow, and lowest rescue inhaler usage. All three treatments produced equivalent improvements in spirometry. CONCLUSIONS: Patients preferred once-daily combination therapy, but this had no greater effect on inflammatory markers than therapy with BUD alone. FM alone had no anti-inflammatory activity but exhibited bronchoprotection. This emphasizes the importance of first optimizing anti-inflammatory control with inhaled corticosteroids before considering adding a regular long-acting beta(2)-agonist.     

Opioid modulation of FSH, growth hormone and prolactin secretion in the prepuberal gilt.

The role of endogenous opioid peptides (EOP) in modulating GH, prolactin (PRL) and FSH secretion was evaluated in prepuberal (P) gilts. In experiment I, P gilts received 1 (n = 2), 3 (n = 3) or 6 (n = 3) mg naloxone (NAL)/kg body weight i.v. Blood was collected every 15 min for 2 h prior to and 2 h after NAL and an additional 1 h after 100 micrograms gonadotrophin-releasing hormone (GnRH) i.v. In experiment II, P and mature (M) gilts were ovariectomized. Three weeks after ovariectomy, P and M gilts were injected twice a day for 10 days with either 0.85 mg progesterone (P4)/kg body weight or oil vehicle (V), resulting in the following groups: PP4 (n = 11), PV (n = 10), MP4 (n = 11) and MV (n = 10). All gilts received 1 mg NAL/kg body weight on the last day of treatment. Blood samples were collected every 15 min for 4 h before and 2 h after NAL and an additional 1 h after 100 micrograms GnRH i.v. In experiment III, six P and five M gilts were ovariectomized and surgically implanted with intracerebroventricular (i.c.v.) cannulae. Blood was collected every 15 min for 3 h before and 3 h after i.c.v. injection of 500 micrograms morphine in artificial cerebrospinal fluid (CSF) or 250 microliters CSF. In experiment I, all doses of NAL failed to alter PRL secretion, while NAL increased (P less than 0.05) GH secretion in three out of eight gilts. However, NAL suppressed (P less than 0.05) FSH concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)     

Efficacy and safety of the single-capsule combination of fluticasone/formoterol in patients with persistent asthma: a non-inferiority trial

OBJECTIVE:

Fluticasone and formoterol are effective in the treatment of asthma. When a corticosteroid alone fails to control asthma, combination therapy is the treatment of choice. The objective of this study was to compare the efficacy and safety of formulations containing budesonide/formoterol (BUD/FOR), fluticasone alone (FLU), and the single-capsule combination of fluticasone/formoterol (FLU/FOR) on lung function in patients with mild-to-moderate persistent asthma.

METHODS:

This was a randomized, multicenter, open phase III trial conducted in Brazil. The primary efficacy analysis was the assessment of non-inferiority between FLU/FOR and BUD/FOR combinations regarding FEV₁ (in L) at the final visit. The secondary analyses were PEF, level of asthma control, serum cortisol levels, frequency of adverse events, adherence to treatment, and appropriate inhaler use.

RESULTS:

We randomized 243 patients to three groups: FLU/FOR (n = 79), BUD/FOR (n = 83), and FLU (n = 81). In terms of the mean FEV₁ after 12 weeks of treatment, the difference between the FLU/FOR and BUD/FOR groups was 0.22 L (95% CI: −0.06 to 0.49), whereas the difference between the FLU/FOR and FLU groups was 0.26 L (95% CI: −0.002 to 0.52). Non-inferiority was demonstrated by the difference between the lower limits of the two 95% CIs (−0.06 vs. −0.002). The level of asthma control and PEF were significantly greater in the FLU/FOR and BUD/FOR groups than in the FLU group. There were no significant differences among the groups regarding patient adherence, patient inhaler use, or safety profile of the formulations.

CONCLUSIONS:

The single-capsule combination of FLU/FOR showed non-inferiority to the BUD/FOR and FLU formulations regarding efficacy and safety, making it a new treatment option for persistent asthma.     

Combined effects of an anticoagulant and a lipid‐lowering agent on the prevention of steroid‐induced osteonecrosis in rabbits

Objective

To investigate the effects of combination treatment with an anticoagulant (warfarin) plus a lipid‐lowering agent (probucol) on the prevention of steroid‐induced osteonecrosis (ON) in rabbits.

Methods

Adult male Japanese white rabbits were injected once intramuscularly with 20 mg/kg of methylprednisolone acetate into the right gluteus medius muscle. The rabbits were then divided into 4 groups and treated as follows: one group received warfarin plus probucol (WP; n = 25), one received probucol alone (PA; n = 30), one received warfarin alone (WA; n = 26), and one received no treatment (nonprophylactic [NP]; n = 20). Two weeks after the steroid injection, the femora and humeri were examined histopathologically for the presence of ON. The sizes of the bone marrow fat cells were examined morphologically. Hematologic examinations were performed before and after the steroid injection.

Results

The incidence of ON in the WP group (5%) was significantly lower than that observed in the NP group (70%). While the incidence rates of ON in the PA (38%) and WA (33%) groups were also significantly lower than that in the NP group, they were significantly higher than that observed in the WP group. The sizes of the bone marrow fat cells in both the WP (53.5 ± 4.1 μm) and the PA (52.0 ± 5.0 μm) groups were significantly smaller than those in the NP group (60.0 ± 4.0 μm). We also observed a prolongation of the prothrombin time and a reduction in the plasma lipid levels in the WP group during the study.

Conclusion

This study experimentally confirmed that the combined use of an anticoagulant and a lipid‐lowering agent helps prevent steroid‐induced ON in rabbits.

     

Lack of additional effects of long‐term,low‐dose clarithromycin combined treatment compared with topical steroids alone for chronic rhinosinusitis in China: a randomized,controlled trial

Background

In China, clarithromycin is considered an effective treatment option for chronic rhinosinusitis (CRS) due to its unique immunopathologic characteristics. Our study's aim was to determine whether a topical steroid and clarithromycin combination is better than a single topical steroid for Chinese patients with CRS.

Methods

Patients with CRS with/without nasal polyps were included in this study and randomly assigned to a clarithromycin plus budesonide aqua nasal spray group (CLM + BUD, clarithromycin 0.25 g/d and budesonide 256 μg/d) or a budesonide‐alone group (BUD, budesonide 256 μg/d). The treatment period was 3 months. The primary outcome was visual analog scale (VAS) score for 5 major symptoms and a general nasal symptom. Other assessments included the 22‐item Sino‐Nasal Outcome Test (SNOT‐22), computed tomography scan (Lund‐Mackay score), and rigid nasal endoscopy (Lund‐Kennedy score). Nasal secretion evaluation was the secondary outcome.

Results

Seventy‐four patients were included and randomly assigned to the CLM + BUD group (n = 38) or the BUD group (n = 36). VAS scores for nasal obstruction, rhinorrhea, smell reduction, headache, nasal pain, and general nasal symptom were markedly improved in both treatment arms, but the differences between groups were not significant. Furthermore, SNOT‐22, Lund‐Mackay, and Lund‐Kennedy scores improved significantly after treatment in both groups, and were slightly better in the CLM + BUD group. For the responders in the CLM + BUD group, interleukin (IL)‐6 and IL‐8 were markedly reduced.

Conclusion

The combination of CLM + BUD for the treatment of first‐time‐diagnosed CRS in this Chinese population cohort did not show a better effect compared with a single BUD regimen, but it may have a better effect in some patients with increased IL‐6 or IL‐8.     

Systemic effects of inhaled fluticasone propionate and budesonide in adult patients with asthma.

We assessed the systemic effects of budesonide (BUD) and fluticasone propionate (FP) in 23 patients with asthma, using a double-blind, placebo-controlled, double-dummy, and cross-over design. The following five treatments were given in a randomized order for 1 wk with a washout period in between of 2 wk: (1) placebo; (2) FP, 200 micrograms twice a day, inhaled from a Diskhaler; (3) FP, 1,000 micrograms twice a day, inhaled from a Diskhaler; (4) BUD, 200 micrograms twice a day, inhaled from a Turbuhaler; and (5) BUD, 800 micrograms twice a day, inhaled from a Turbuhaler. The primary variable was the area under the curve of serum cortisol versus time (AUC0-20), derived from serum samples taken every 2 h over a 20-h period following the last evening dose at 10:00 P.M. The lower doses of BUD and FLU did not cause any adrenal suppression. Compared with placebo, however, FP (1, 000 micrograms, twice daily and BUD (800 micrograms, twice daily) decreased the AUC0-20 by 34 and 16%, respectively. Fluticasone (1,000 micrograms, twice daily) was more suppressive than BUD (800 micrograms, twice daily) (p = 0.0006). The FEV1, measured the morning after the last inhalation, was significantly higher after the active treatments, compared with placebo (p < 0.02), but did not differ between all active treatments. We conclude that high doses of BUD and FP (in particular the latter), inhaled via their respective dry powder inhalers for 1 wk, result in a measurable systemic activity in patients with asthma.