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。     

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.     

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FP4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500μg/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2000μg/d,与肾上腺功能异常呈线性关系。结论常规应用FP200～500μg/d是安全的,对肾上腺功能的影响很小。     

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。     

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。     

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。     

丙酸氟替卡松鼻喷剂治疗分泌性中耳炎疗效观察

目的探讨丙酸氟替卡松鼻喷剂治疗分泌性中耳炎的临床疗效。方法选择2011年6月至2012年5月SOM患者80例,随机分为对照组和观察组,对照组采用常规治疗方法,观察组加用丙酸氟替卡松鼻喷剂治疗3周后,观察第一周及第三周的治疗疗效,鼓室压力及语频气导值。结果两组资料均达到满意疗效,比较结果后,加用丙酸氟替卡松观察组起效更快(P<0.05)。结论丙酸氟替卡松治疗分泌性中耳炎结合常规治疗能较快达到满意疗效。     

沙美特罗/丙酸氟替卡松联合孟鲁斯特对重度哮喘肺通气功能及安全性研究

目的研究沙美特罗/丙酸氟替卡松联合孟鲁斯特对重度哮喘的肺通气功能及安全性的影响。方法选择本院2011年1月—2011年10月的26例重度哮喘患者为研究对象,对患者进行沙美特罗/丙酸氟替卡松50/25μg,2次/d吸入,疗程为6周。治疗前后对患者肺功能各项指标进行测定,并观察用药期间的不良反应。结果治疗后患者的肺通气功能的指标与治疗前比较,差异均有统计学意义(P<0.05);不良反应发生率为7.7%。结论沙美特罗/丙酸氟替卡松联合孟鲁斯特治疗重度哮喘能很好地改善肺通气功能,且安全性和耐受性能得到保证。     

吸入性布地奈德、丙酸氟替卡松治疗COPD的临床疗效观察

目的观察布地奈德、丙酸氟替卡松雾化吸入治疗COPD的临床疗效。方法将210例COPD患者随机分为:A组68例,B组72例和对照组70例,3组均采用综合治疗。A组沙丁胺醇加用布地奈德雾化吸入治疗;B组沙丁胺醇加用丙酸氟替卡松雾化吸入治疗。观察测定3组患者的临床疗效及住院天数等,随访停药1a为喘息性疾病患病人数及患病率。结果 A、B组住院天数、喘憋持续时间、咳嗽持续时间、哮鸣音持续时间方面明显短于对照组,B组明显优于A组,差异均有统计学意义;B组总有效率100.0%,明显高于对照组94.3%;B组喘息性疾病的发病率9.7%,明显低于对照组34.3%和A组25.0%,差异有统计学意义(P<0.05)。结论糖皮质激素布地奈德、丙酸氟替卡松联合沙丁胺醇雾化吸入治疗COPD具有较好的临床疗效。     

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     

Beclometasone dipropionate extrafine aerosol versus fluticasone propionate in children with asthma

Beclometasone dipropionate (BDP) extrafine is a hydrofluoroalkane-based, chlorofluorocarbon (CFC)-free inhalation aerosol. This study was conducted to determine whether BDP extrafine and CFC-fluticasone proprionate (FP) aerosols were equivalent in terms of efficacy and tolerability in children with symptomatic mild-to-moderate asthma. Male and female patients (aged 5-12 yr) with an asthma diagnosis for > or =3 months, peak expiratory flow (PEF) > or =60% of predicted normal and suboptimal asthma control were randomised to double-blind treatment with BDP extrafine 200 microg day(-1) (n=139) or CFC-FP 200 microg day(-1) (n=141) for up to 18 weeks. After 6 and 12 weeks, study medication was 'stepped down' to 100 and 50 microg day(-1), respectively, if patients had achieved good asthma control. Patients with poor asthma control discontinued from the study and those with intermediate control continued in the study but did not undergo a dose reduction. The estimated treatment difference in morning PEF% predicted at 6 weeks was -1.9% (90% CI -4.9, 1.0). There was a trend towards a greater increase in forced vital capacity (% predicted) in the BDP extrafine group (5.3 versus 0.4%; p=0.084). A 'step-down' in therapy to 100 microg day(-1) was possible in 36% and 42% of patients in the BDP extrafine and CFC-FP groups, respectively, at 6 weeks. Both drugs were well tolerated. BDP extrafine and CFC-FP aerosols were equally effective at improving asthma control in children with mild-to-moderate asthma at the same daily dose.     

Growth during one year of treatment with fluticasone propionate or sodium cromoglycate in children with asthma

The aim of this study was to compare accurately measured growth over 12 months in asthmatic children treated with either fluticasone propionate (FP) 50 μg twice daily (bid) or sodium cromoglycate (SCG) 20 mg four times daily (qid). After a 2-week run-in, asthmatic children aged 4–10 years from 15 UK centers were randomized in a 3:4 ratio to open-label FP (n = 52) or SCG (n = 70). After 8 weeks, those whose asthma was not adequately controlled were switched from SCG to FP or withdrawn. Standing height was measured (Holtain stadiometry) at baseline, after 8 weeks and at 6 week intervals thereafter for 1 year. Morning peak flows (PEF_am) were recorded by patients for 2 weeks during baseline, and 1 week before each visit during treatment. Urinary free cortisol (24 h) was measured at baseline, 6 months, and 1 year. After 8 weeks, 22 patients were withdrawn from SCG group (and were switched to FP), and five patients were withdrawn from the FP group due to poor asthma control. A further 21 and 11 patients were withdrawn from the SCG and FP groups, respectively, during the course of the study. There were no significant differences between patients who received FP and SCG for 1 year (n = 34 and n = 26, respectively) in terms of height velocity adjusted for age and gender (HV), or height velocity standard deviation scores adjusted for gender (HVSDS). Mean HV (mean HVSDS) were 6.0 cm/yr (0.1) and 6.5 cm/yr (0.5) for FP and SCG, respectively. There were no treatment differences in mean 24 h urinary free cortisol levels at 6 and 12 months. Mean % predicted PEF_am improved over 1 year in both groups but to a greater degree in the FP group. We concluded that growth was normal in mildly asthmatic children receiving FP (50 μg bid) for 1 year. There were fewer withdrawals and lung function improved to a greater extent in FP treated patients than in patients receiving SCG. Pediatr. Pulmonol. 1997; 24:178–186. © 1997 Wiley-Liss, Inc.     

Step-down compared to fixed-dose treatment with inhaled fluticasone propionate in asthma

BACKGROUND: Inhaled corticosteroids (ICSs) are an effective treatment of asthma even when administered at a low dose. Once asthma is controlled, current guidelines recommend that the dose of ICS be reduced to the lowest possible and effective dose. Although the most appropriate strategy for the stepping down has not yet been defined, quantification of sputum eosinophils and bronchial hyperresponsiveness (BHR) are indeed measures of asthma control. OBJECTIVE: To compare the efficacy of step-down and fixed-dose strategies in the control of BHR to methacholine and eosinophilic inflammation patients with mild-to-moderate asthma. METHODS: We performed a double-blind, randomized study to compare inhaled fluticasone propionate (FP), 1,000 microg/d, then reduced to 200 microg/d (group 1; n = 18) to a fixed dose of FP, 200 microg/d (group 2; n = 17) administered for 6 weeks and then 8 weeks in reducing the provocative dose of methacholine causing a 20% fall in FEV1 (PD20) and sputum eosinophils in 35 patients. The duration of the efficacy was also followed subsequently after 8 weeks of placebo treatment. RESULTS: PD20 remarkably increased with both treatment strategies, but differences between groups were not significant. Sputum eosinophils (median values, percentage) at baseline and after each treatment period were not different (group 1, 16.4 to 1.0 to 2.7%; group 2, 16.7 to 2.8 to 2.8%, respectively). The percentages of patients in whom sputum eosinophilia was normalized (< or = 3%) were as follows: group 1, 69% and 60%; group 2, 50% and 57%. After placebo treatment, sputum eosinophils were still "normalized" in approximately one third of patients. CONCLUSION: Step-down and fixed-dose strategies with FP improved PD20 and sputum eosinophilia to a similar degree. The effect on sputum eosinophils persisted longer than that on methacholine.     

Adrenal suppression from high-dose inhaled fluticasone propionate in children with asthma.

This cross-sectional study was designed to examine the prevalence of adrenocortical suppression in children with asthma treated with high-dose inhaled fluticasone propionate (FP). Children and adolescents (n=50) with asthma, treated with inhaled FP at a dose of > or = 1,000 mg a day for > or = 6 months, were enrolled. Early morning serum cortisol was performed. Subjects with a serum cortisol of < 400 nmol x L(-1) had a tetracosactrin stimulation test. Fifty subjects of mean age 13.1 yrs were treated with a mean dose of 924.7 microg x m(-2) x day(-1) FP for a mean duration of 2 yrs. Of the 50 subjects, 36 (72%) had serum cortisol levels of < 400 nmol x L(-1) and underwent tetracosactrin stimulation test. Of these, 6 (17%) demonstrated a less than two-fold increase in serum cortisol from baseline and peak cortisol level of < or = 550 nmol x L(-1) at 30 or 60 min poststimulation. There was a significant negative correlation between the dose of FP x m(-2) and stimulated peak cortisol level. Biochemical evidence of adrenocortical insufficiency was demonstrated in 12% of the subjects, indicating that high-dose fluticasone propionate use may be associated with dose-dependent adrenocortical suppression.     

Addition of salmeterol to fluticasone propionate treatment in moderate-to-severe asthma

This study was designed to determine whether the benefit of adding salmeterol was superior to doubling the dose of fluticasone propionate (FP) over 6 months, compared to a control group who remained on a lower dose of FP. The multi-centre, double-blind, parallel group study involved 496 symptomatic asthmatic patients with a history of exacerbations on 500-800 micrograms (microg) inhaled corticosteroids (ICS) twice daily (b.d.) in a broadly representative group of 100 hospitals and general practices in six countries. Two doses of FP--250 microg b.d. (FP250) or 500 microg b.d. (FP500)--were compared with the lower dose of FP plus a long-acting beta2-agonist, salmeterol 50 microg b.d. (SM/FP250). Patients symptomatic on the run-in dose of FP250 alone formed the control group in the treatment period. Over 6 months, SM/FP250 significantly improved mean morning peak expiratory flow rates (amPEF) by 42.1 l/min, more than twice the improvement achieved with either dose of FP alone. SM/FP250 also resulted in more symptom-free days and nights (P < 0.002) and days and nights with no relief medication (P < 0.001). The number of severe exacerbations was low: 3, 6 and 8% in the SM/FP250, low- and high-dose FP groups, respectively. This study confirms that adding salmeterol to low-dose inhaled FP offers greater improvements than either maintaining or doubling the dose of FP. Significant benefit was gained from adding salmeterol in a group of patients who appeared to have been at the top of their steroid dose-response curve receiving FP250. There was no evidence of tolerance and a low incidence of exacerbations in all treatment groups.     

Dose-responses over time to inhaled fluticasone propionate treatment of exercise- and methacholine-induced bronchoconstriction in children with asthma

When treating bronchial hyperresponsiveness to so-called direct and indirect stimuli, distinct pathophysiological mechanisms might require differences in dose and duration of inhaled corticosteroid therapy. To test this hypothesis in children with asthma, we investigated the time- and dose-dependent effects of 2 doses of fluticasone propionate (FP, 100 or 250 microg bid.) in improving exercise- (EIB) and methacholine-induced bronchoconstriction during 6 months of treatment, using a placebo-controlled parallel group study design. Thirty-seven children with asthma (aged 6 to 14 years; forced expired volume in 1 sec (FEV(1)) >/=70% predicted; EIB >/=20% fall in FEV(1) from baseline; no inhaled steroids during the past 4 months) participated in a double-blind, placebo-controlled, 3-arm parallel study. Children receiving placebo were re-randomized to active treatment after 6 weeks. Standardized dry air treadmill exercise testing (EIB expressed as %fall in FEV(1) from baseline) and methacholine challenge using a dosimetric technique (expressed as PD(20)) were performed repeatedly during the study. During FP-treatment, the severity of EIB decreased significantly as compared to placebo within 3 weeks, the geometric mean % fall in FEV(1) being reduced from 34.1% to 9.9% for 100 microg FP bid, and from 35.9% to 7.6% for 250 microg FP bid (P < 0.05). These reductions in EIB did not differ between the 2 doses and were sustained throughout the treatment period. PD(20) methacholine improved significantly during the first 6 weeks as compared to placebo (P < 0.04) and steadily increased with time in both treatment limbs (P = 0.04), the difference in improvement between doses (100 microg FP bid, 1.6 dose steps; 250 microg FP bid, 3.3 dose steps) approaching significance after 24 weeks (P = 0.06). We conclude that in childhood asthma, the protection afforded by inhaled fluticasone propionate against methacholine-induced bronchoconstriction is time- and dose-dependent, whereas protection against EIB is not. This suggests different modes of action of inhaled steroids in protecting against these pharmacological and physiological stimuli. This has to be taken into account when monitoring asthma treatment.     

沙美特罗替卡松吸入联合顺尔宁口服治疗儿童哮喘疗效分析

目的探讨沙美特罗替卡松吸入联合顺尔宁口服治疗儿童哮喘的临床疗效。方法将116例哮喘患儿随机分入对照组与观察组,给予56例对照组沙美特罗替卡松吸入治疗,60例观察组患者接受沙美特罗替卡松吸入联合顺尔宁口服,疗程12周,比较两组临床疗效及肺功能的改变。结果观察组治疗有效率显著高于对照组(60.0%vs 37.5%,P<0.05);观察组治疗后日间哮喘症状评分及夜间哮喘症状评分均显著低于对照组(P<0.05);观察组肺功能指标FEV1%和PEF预计值%显著优于对照组(P<0.05)。结论沙美特罗替卡松吸入联合顺尔宁口服治疗儿童哮喘可显著提高临床疗效,改善患儿肺功能。     

Effect of high-dose fluticasone propionate on bone density and metabolism in children with asthma

Significant concern remains over the long-term side effects of inhaled steroids. This cross-sectional study evaluates the effect of high-dose inhaled fluticasone propionate (FP) on biochemical markers of bone metabolism and bone density in children with asthma. Children with chronic asthma using FP >/= 1,000 mcg daily for at least 6 months, and healthy controls, were entered in the study. No children had taken oral prednisolone within the previous month. Fasting morning serum was analyzed for bone formation markers, and spot urine for bone resorption markers. Dual-energy X-ray absorptiometry (DEXA) results were reviewed in a subgroup of patients. Forty-nine children with asthma and 32 controls were recruited. The mean FP dose was 771.2 +/- 253.35 mcg/m2/day. Unpaired t-test analysis revealed no significant difference in biochemical markers studied. In subjects with asthma; 13 of 37 (35.1%) had lumbar spine density more than one standard deviation below the mean (P = 0.001). This fell to 6/37 (16.2%) with bone age correction (NS). In conclusion, no significant reduction in bone metabolism or bone age-corrected bone mineral density was observed in children with asthma on prolonged high doses of inhaled FP.     

A comparison of the relative growth velocities with budesonide and fluticasone propionate in children with asthma

There have been no previous large, well-designed direct comparisons of the effects of fluticasone propionate (FP) and budesonide (BUD) on growth in children. This randomised, double-blind study compared the effects on growth of FP and BUD in children aged 6-9 years with persistent asthma. Following a 6-month run-in period (without inhaled corticosteroids), patients with normal growth velocity were randomised to 12 months' treatment with FP 100 micro g bd (n=114) or BUD 200 micro g bd (n=119). Growth velocity was determined by stadiometric height measurement. Lung function, asthma symptoms and use of relief medication were also assessed. Annualised mean growth velocity during run-in was comparable in the two groups (FP: 5.9 cm/yr; BUD: 6.0 cm/yr). During the treatment period, adjusted mean growth velocity was significantly higher in the FP than the BUD group (5.5 cm/yr vs 4.6 cm/yr; P<0.001). Asthma control improved similarly in both treatment groups. Bone mineral density and overnight urinary cortisol:creatinine ratios were similar in the two groups. Drug-related adverse events were reported among 3% of FP-treated children, compared with 2% for BUD. In conclusion, this study demonstrates that FP for childhood asthma has significantly less impact on childhood growth velocity than a therapeutically equivalent dose of BUD.