吸烟对支气管哮喘患者吸入糖皮质激素治疗的影响

目的 探讨吸烟对支气管哮喘(简称哮喘)患者临床症状、肺功能及气道炎症的影响,以及对激素治疗的敏感性.方法 选取2009年1 2月至2011年1月门诊就诊的40例慢性持续期哮喘患者,根据是否吸烟分为吸烟组(15例)和非吸烟组(23例).所有患者给予糖皮质激素(布地奈德)吸入治疗,必要时可吸入β2受体激动剂.发放哮喘日记卡及峰流速仪.记录治疗前及治疗28 d后哮喘症状评分、哮喘控制测试(ACT)评分、肺功能、晨间及夜间最高呼气流速(PEF),诱导痰中嗜酸粒细胞及中性粒细胞百分比,并测定痰液中白介素8(IL-8)及嗜酸粒细胞趋化因子(eotaxin)水平.结果 两组患者治疗前除性别构成外,年龄、病程、ACT评分、肺功能指标差异均无统计学意义.两组患者治疗后ACT评分(F=39.991,P<0.05)、FEV1%pred(F＝56.075,P<0.05)、PEV1%pred(F＝53.535,P<0.05),嗜酸粒细胞百分比(F＝15.271,P<0.05)及eotaxin(F=24.172,P<0.05)水平均较治疗前有明显改善,哮喘症状评分显著降低(P<0.05).其中非吸烟组以上指标的改善程度均优于吸烟组(P<0.05).结论 吸烟降低了哮喘患者对ICS治疗的反应性.对吸烟的哮喘患者,治疗可能需要特殊调整.     

吸烟对支气管哮喘患者吸入糖皮质激素治疗的影响

目的 探讨吸烟对支气管哮喘(简称哮喘)患者临床症状、肺功能及气道炎症的影响,以及对激素治疗的敏感性.方法 选取2009年12月至2011年1月门诊就诊的40例慢性持续期哮喘患者,根据是否吸烟分为吸烟组(15例)和非吸烟组(23例).所有患者给予糖皮质激素(布地奈德)吸入治疗,必要时可吸入β2受体激动剂.发放哮喘日记卡及峰流速仪.记录治疗前及治疗28 d后哮喘症状评分、哮喘控制测试(ACT)评分、肺功能、晨间及夜间最高呼气流速(PEF),诱导痰中嗜酸粒细胞及中性粒细胞百分比,并测定痰液中白介素8(IL 8)及嗜酸粒细胞趋化因子(eotaxin)水平.结果 两组患者治疗前除性别构成外,年龄、病程、ACT评分、肺功能指标差异均无统计学意义.两组患者治疗后ACT评分(F=39.991,P＜0.05)、FEV1％ pred(F=56.075,P＜0.05)、PEF％ pred(F=53.535,P＜0.05),嗜酸粒细胞百分比(F=15.271,P＜0.05)及eotaxm(F=24.172,P＜0.05)水平均较治疗前有明显改善,哮喘症状评分显著降低(P ＜0.05).其中非吸烟组以上指标的改善程度均优于吸烟组(P＜0.05).结论 吸烟降低了哮喘患者对ICS治疗的反应性.对吸烟的哮喘患者,治疗可能需要特殊调整.     

吸烟对支气管哮喘患者糖皮质激素治疗的影响

目的通过本实验进一步探讨吸烟对支气管哮喘(简称哮喘)患者气道炎症的影响,了解吸烟哮喘患者对激素治疗的敏感性。方法选取35例慢性持续期哮喘患者,根据是否吸烟,分为吸烟组14例和非吸烟组21例。所有患者给予吸入糖皮质激素(ICS)治疗,必要时可吸入β2受体激动剂,发放哮喘日记卡及峰流速仪。分别记录治疗前及治疗28d后哮喘症状评分、哮喘控制测试(ACTTM)评分;第一秒用力呼气容积占预计值百分比(FEV1占预计值%)、第一秒用力呼气容积占用力肺活量百分比(FEV1/FVC%)、最大呼气流速占预计值百分比(PEF占预计值%)、每日晨间及夜间PEF;诱导痰中嗜酸粒细胞及中性粒细胞百分比并测定痰液中白介素8(IL-8)及嗜酸粒细胞趋化因子(eotaxin)水平。结果两组患者ICS治疗后ACTTM评分有明显改善,组间ACTTM评分比较差异具有统计学意义(t=5.542,P<0.05)。治疗后两组哮喘患者肺功能均有改善,组间比较FEV1占预计值%(t=4.740,P<0.05)、PEF占预计值%(t=5.190,P<0.05)差异有统计学意义。两组患者ICS治疗后组内比较嗜酸粒细胞百分比、eotaxin水平差异均有统计学意义。中性粒细胞百分比治疗前、后差异无统计学意义。治疗后组间比较中性粒细胞(t=7.707,P<0.05)、IL-8水平(t=4.557,P<0.05)、嗜酸粒细胞百分比(t=4.740,P<0.05)及eotaxin水平(t=2.064,P<0.05)差异均有统计学意义。结论两组患者ICS治疗28d后,其临床症状、肺功能及痰中炎性介质均有改善,但吸烟组改善程度较非吸烟组差。吸烟组哮喘患者诱导痰中中性粒细胞及IL-8水平高于非吸烟组哮喘患者,而嗜酸粒细胞及eotaxin水平低于后者。     

吸烟对轻度支气管哮喘患者吸入激素疗效的影响

目的　观察吸烟对轻度支气管哮喘患者吸入激素疗效的影响。方法　对不吸烟 (1 8例 )及吸烟 (1 7例 )的支气管哮喘患者每日吸入二丙酸倍氯米松 5 0 0μg治疗 4周 ,治疗前后进行肺功能测定及气道反应性试验 ,用药过程中监测呼气峰流速 (peak expiratory flow,PEF)。结果　不吸烟组患者治疗后的清晨 PEF、睡前 PEF、FEV1 %及气道反应性均较治疗前改善 (P<0 .0 5 )。而吸烟组患者在治疗前后上述指标却变化不大 (P>0 .0 5 )。结论　吸烟能明显减弱支气管哮喘患者吸入激素的疗效 ,支气管哮喘患者应积极戒烟以取得较好的疗效     

Lung function in school-aged asthmatic children with inhaled cromoglycate, nedocromil and corticosteroid therapy.

Two-thirds of the children with asthma in our area use cromones and only one-third steroids as the maintenance therapy. This study aimed to evaluate our treatment policy based on the international consensus. Peak expiratory flow (PEF), dynamic spirometry and bronchodilation test results were therefore collected in 195 school-aged patients who visited our outpatient clinic in 1995. Sixty-four children (33%) used cromoglycate, 86 (44%) nedocromil and 45 (23%) inhaled steroids. Twenty-five (12%) needed combination therapy, mainly with salmeterol. Lung function results were good, and there were no significant differences between the therapeutic groups irrespective of whether pre- or postbronchodilator values were considered. PEF was decreased in eight (4%), forced expiratory volume in one second (FEVI) in four (2%) and maximum mid-expiratory flow (MMEF) in 33 (17%) patients. At least one result was decreased in 39 (20%) cases, in most cases (77%) MMEF alone. Significant rises after salbutamol inhalations were observed in 17 (9%) in PEF, in two (1%) in FEV1 and 20 (10%) in MMEF values. Thus, the bronchodilation test was positive in 33 (17%) cases, and in 22 (11%) cases it was the only sign of bronchial obstruction. Over 70% of the children with asthma can be treated with cromones by a stepwise treatment modality. Inhaled steroids can be restricted to those not controllable by cromones. Lung function tests, including postbronchodilator values, should be part of the follow-up of continuous maintenance medication for asthma.     

Prospective study of inhaled corticosteroid use, cardiovascular mortality, and all-cause mortality in asthmatic women

BACKGROUND: Therapy with inhaled corticosteroids (ICSs) decreases the risk of asthma exacerbations. Recent studies have suggested that ICS therapy also may decrease the risk of cardiovascular disease, and perhaps of all-cause mortality. We examined this hypothesis in a large, well-characterized cohort of asthmatic women. METHODS: In 1976, the Nurses' Health Study enrolled 121,700 registered nurses, who were 30 to 55 years of age. Participants were asked about "physician-diagnosed asthma" on biennial questionnaires. In 1998, asthmatic participants were sent a supplementary questionnaire on asthma diagnosis and management, including ICS use. Mortality was assessed through 2003, without knowledge of the 1998 (baseline) ICS status. The odds ratios (ORs) for death were adjusted for age, asthma severity, smoking, heart disease, cancer, stroke, aspirin, and statin use. RESULTS: Among 2,671 eligible women (ie, those who responded to the 1998 supplement [85%], met criteria for persistent asthma, and had not received a prior diagnosis of COPD), 54% reported ICS use. Over the next 5 years, 87 women (3.3%) died (cardiovascular deaths, 22; cancer deaths, 31; other, 34 [including 4 from asthma]). Compared to asthmatic women who did not use ICSs, those receiving therapy with ICSs had lower all-cause mortality (OR, 0.58; 95% confidence interval [CI], 0.36 to 0.92). ICS users were at significantly lower risk of cardiovascular death (OR, 0.35; 95% CI, 0.13 to 0.93), but not of death from cancer (OR, 0.66; 95% CI, 0.32 to 1.38) or other causes (OR, 0.62; 95% CI, 0.30 to 1.27). CONCLUSIONS: ICS use was associated with significantly lower cardiovascular and all-cause mortality in women with asthma. These observational data suggest that ICSs may indeed have antiinflammatory benefits beyond the airway, which is a possibility that merits further study.     

Increased risk of nontuberculous mycobacterial infection in asthmatic patients using long-term inhaled corticosteroid therapy

Background and objective: The risk of pneumonia is increased among COPD patients using inhaled corticosteroids (ICS). However, there is uncertainty regarding the association between long‐term use of ICS and exacerbations of respiratory tract infections among asthmatic patients. Methods: A case‐control nested cohort study was performed to assess the association of asthma with nontuberculous mycobacterium (NTM) infection. Results: Among this cohort of 464 asthmatic patients, 14 experienced complications due to NTM infections, of which eight were caused by Mycobacterium avium‐intracellulare complex, three by M. kansasii, one by M. terrae and the remaining two by unclassifiable scotochromogens. Asthmatic patients with NTM infections were older (67.1 ± 8.6 vs 58.8 ± 12.3 years, P < 0.01) and had more severe airflow limitation (FEV₁%, 60.6 ± 10.3 vs 72.3 ± 18.3, P < 0.03) than those without NTM infections. All except one had received ICS treatment for more than 5 years, and 12 of the 14 patients used inhaled fluticasone propionate daily (four patients at a dose of 400 µg/day and eight patients at a dose >800 µg/day). Conclusions: These findings suggest that the risk of NTM infection may be greater in asthmatic patients who are older, have more severe airflow limitation and receive higher doses of ICS therapy.     

Effect of an inhaled corticosteroid on airway inflammation and symptoms in asthma.

The effect of inhaled corticosteroid therapy on airway mucosal inflammation was investigated in 10 symptomatic atopic asthmatic patients treated with inhaled albuterol and whose disease severity required preventative antiinflammatory treatment. Endobronchial biopsies were obtained by fiberoptic bronchoscopy before and after 6 wk of therapy with inhaled beclomethasone dipropionate (2,000 micrograms/day for 2 wk followed by 1,000 micrograms/day for 4 wk). Following treatment, there was a significant increase in mean morning peak expiratory flow (p less than 0.05) and baseline FEV1 measured on the day of methacholine challenge (p less than 0.05) and a decrease in asthma symptoms (p less than 0.01), peak expiratory flow variation (p less than 0.05), and albuterol usage (p less than 0.05). This was accompanied by a sevenfold decrease in airway responsiveness (p = 0.001). The clinical improvement in asthma was associated with a significant (p less than 0.05) reduction in epithelial and mucosal mast cells and eosinophils and submucosal T lymphocytes, but electron microscopy did not identify any changes in the extent of mast cell and eosinophil degranulation following treatment. Because of the association between the decrease in inflammatory cell numbers and the improvement in all the measured clinical and physiologic indices of asthma, we suggest that the beneficial effect of inhaled corticosteroids in asthma may be attributed to their antiinflammatory action in the bronchial mucosa.     

Withdrawal of inhaled corticosteroid therapy in long-term, stable, mild to moderate, persistent asthmatic patients.

We aimed to evaluate the effect of withdrawal of inhaled corticosteroid (ICS) therapy on the course of mild to moderate asthma. Nineteen cases with stable, mild to moderate asthma were included in this study. Patients had used ICSs regularly during the past year and had no symptoms and signs for the last 3 months prior to the study. The patients were randomized into two groups. Group 1 included 11 patients who were followed after withdrawal of ICS therapy (mean age 48.8 +/- 13.1 years; M/F: 2/9), while Group 2 included 8 patients still taking ICS therapy (mean age 47.2 +/- 14.8 years; M/F: 4/4). All subjects were seen at the end of the 1st (V2), 2nd (V3), 3rd (V4), 6th (V5), and 12th (V6) months. Symptom scores and FEV1 measurements were evaluated during these visits. Patients with relapses were excluded from the study. Bronchial challenge test was applied in all cases at V0, V4, V5, and V6. In 10 of 11 cases (90.9%) in which ICS therapy was discontinued, relapse was observed in 1.55 +/- 0.86 months, while in 2 of 8 subjects (25%) still taking ICSs, relapse occurred after 3.76 +/- 1.99 months. In Group 1, "mean symptom score" and "mean PC20FEV1" values measured during the whole follow-up period were found to be lower than in Group 2. We concluded that withdrawal of ICS therapy could increase the possibility of relapse in mild to moderate asthma even in asymptomatic and stable cases.     

Concurrent use of salmeterol with inhaled corticosteroids is more effective than inhaled corticosteroid dose increases.

This randomized, double-blind, parallel, multi-center study was designed to determine whether the addition of salmeterol to existing inhaled corticosteroid therapy provides greater therapeutic benefit than doubling the dose of inhaled corticosteroids in symptomatic patients with asthma. A total of 514 adults were randomized to either beclomethasone 168 micrograms plus salmeterol 42 micrograms twice daily or beclomethasone 336 micrograms twice daily for 24 weeks. Both treatments resulted in significantly improved symptom control and increased pulmonary function. However, beclomethasone plus salmeterol provided greater improvements than doubling the dose of beclomethasone (p < or = 0.05) in FEV1 and in daily-recorded measurements of morning (38 L/minute versus 20 L/minute after treatment with higher dose beclomethasone) and evening peak expiratory flow, asthma symptom scores, symptom-free days, supplemental albuterol use, and days and nights not requiring albuterol. There were no significant differences between treatment groups in the number of patients with abnormal response to corticotropin stimulation at Treatment Week 24. No treatment differences in asthma exacerbation and adverse event frequency rates were seen. Beclomethasone 168 micrograms plus salmeterol 42 micrograms administered twice daily was superior to beclomethasone 336 micrograms taken twice daily in patients symptomatic on beclomethasone 168 micrograms, with no added safety risks.     

Respiratory diseases and cigarette smoking in a Hispanic population in New Mexico

We have conducted a cross-sectional study of Hispanic residents of a community in New Mexico. A total of 2,111 subjects were recruited from 733 households; the overall participation rates were 68.1% for males and 78.9% for females. For all subjects, a standardized respiratory symptoms questionnaire was completed, spirometric testing was performed, and saliva and end-tidal breath samples were obtained. As in other populations, chronic respiratory symptoms were uncommon in children, and asthma was more prevalent in boys than in girls. In adults, physician-diagnosed chronic bronchitis and emphysema were less prevalent in this population than in a previously studied sample of non-Hispanic whites in New Mexico. Spirometric testing was confirmatory; less than 1% of the Hispanic males and females had chronic air-flow obstruction. The prevalence of cigarette usage in the Hispanics was comparable to data from non-Hispanic whites in New Mexico and from nationwide surveys. However, daily cigarette consumption by the Hispanics in this sample tended to be low, as found in previous studies in New Mexico and elsewhere.     

Salmeterol powder provides significantly better benefit than montelukast in asthmatic patients receiving concomitant inhaled corticosteroid therapy

STUDY OBJECTIVES: Comparison of inhaled salmeterol powder vs oral montelukast treatment in patients with persistent asthma who remained symptomatic while receiving inhaled corticosteroids. DESIGN: Randomized, double-blind, double-dummy, parallel-group, multicenter trials of 12-week duration. SETTING: Outpatients in private and university-affiliated clinics. PATIENTS: Male and female patients > or = 15 years of age with a diagnosis of asthma (baseline FEV(1) of 50 to 80% of predicted) and symptomatic despite receiving inhaled corticosteroids. INTERVENTIONS: Inhaled salmeterol xinafoate powder, 50 microg bid, or oral montelukast, 10 mg qd. Measurements and results: Treatment with salmeterol powder resulted in significantly greater improvements from baseline compared with montelukast for most efficacy measurements, including morning peak expiratory flow (35.0 L/min vs 21.7 L/min; p < 0.001), percentage of symptom-free days (24% vs 16%; p < 0.001), and the percentage of rescue-free days (27% vs 20%; p = 0.002). Total supplemental albuterol use was decreased significantly more in the salmeterol group compared with the montelukast group (- 1.90 puffs per day vs - 1.66 puffs per day; p = 0.004) and nighttime awakenings per week decreased significantly more with salmeterol than with montelukast (- 1.42 vs - 1.32; p = 0.015). Patients treated with inhaled salmeterol were significantly more satisfied with their treatment regimen and how well, how fast, and how long it worked than were patients who were treated with oral montelukast. The safety profiles for the two treatments were similar. CONCLUSION: In patients with persistent asthma who remain symptomatic while receiving inhaled corticosteroids, adding inhaled salmeterol powder provided significantly greater improvement in lung function and asthma symptoms and was preferred by patients over oral montelukast.     

Low-dose inhaled and nasal corticosteroid use and the risk of cataracts.

Orally inhaled corticosteroid use has been convincingly linked to an increase in the risk of cataracts, although the risk at lower doses in common use remains uncertain. The potential risk of cataracts with the use of nasal corticosteroids is unknown. A matched nested case-control analysis was performed in a population-based cohort of elderly people who had been dispensed medications for airway disease, as identified through a universal drug benefit plan. Inhaled corticosteroid use was associated with a dose-related increase in both the risk of all cataracts and severe cataracts requiring extraction, and the increase in risk of severe cataracts was apparent even at daily doses of 相似文献   

Effects of inhaled corticosteroid and short courses of oral corticosteroids on bone mineral density in asthmatic patients : a 4-year longitudinal study.

BACKGROUND: It is not certain whether inhaled corticosteroid (ICS) therapy reduces bone mineral density (BMD) in asthmatic patients. In addition, the potential risk of osteoporosis associated with the rescue use of short courses of oral corticosteroids (SC-OCS) is unclear. OBJECTIVE: To evaluate the effect of inhaled beclomethasone dipropionate (BDP) and SC-OCS on BMD in asthmatic patients. DESIGN: A 4-year longitudinal study. METHOD: Lumbar BMD was measured twice by dual-energy x-ray absorptiometry at a mean (+/- SD) interval of 4.2 +/- 0.1 years in 35 asthmatic adults (15 men and 20 postmenopausal women; mean age at the second evaluation, 60.6 +/- 11.5 years) who had been treated with BDP and SC-OCS. RESULTS: The average period of BDP treatment was 7.7 +/- 2.2 years (range, 4.8 to 13.0 years) at the second evaluation. During the study period, the daily dose of BDP was 765 +/- 389 microg (range, 100 to 1,730 microg), and the frequency of SC-OCS was 1.9 +/- 2.7 courses per year (range, 0.0 to 8.9 courses per year). As a whole, lumbar BMD was unchanged during the course of the study, whereas the Z score (ie, the percentage of normal value predicted from age and sex) increased significantly. Changes in BMD and Z scores in patients receiving high doses of BDP (ie, > 1,000 microg/d; n = 9) were not significantly different from those of patients receiving lower doses (ie, 2.5 courses per year; n = 9) showed a significantly greater loss in BMD and Z score compared with those receiving sporadic courses (ie, 相似文献