吸入性糖皮质激素与呼吸道黏膜免疫系统的关系

呼吸道黏膜免疫系统（respiratory passage mucosa immune system,RMIS）是黏膜免疫系统的重要组成部分,它是保护机体免于病原体侵犯的重要屏障,其中分泌型IgA（sIgA）起到了重要作用。吸入皮质激素（ICSs）在慢性炎症性气道疾病中得到了广泛的运用。综述从RMIS的组成、sIgA的功能、口腔微生态以及ICSs对支气管黏膜免疫的影响等方面进行讨论,旨在更好的认识呼吸道黏膜免疫功能以及更好的使用ICSs。     

Effects of inhaled corticosteroids on growth in asthmatic children

This article presents a brief review of the effects of inhaled corticosteroids on growth in children with asthma. All currently available inhaled corticosteroids, where there is adequate data, have been shown to cause significant growth suppression in children in a dose-dependent manner. It is now apparent that there are differences in the growthsuppressive effects of different corticosteroids. Recent evidence confirms that the growth-suppressive effects are short lived and that, at conventional doses, inhaled corticosteroids do not affect final attained adult height.     

吸入型糖皮质激素副作用的研究进展

本文综述了吸入型糖皮质激素对全身系统的不利影响及国外新的研究进展。高剂量的任何吸入型糖皮质激素都会产生具有临床意义的全身活性。中等剂量的吸入型糖皮质激素可抑制下丘脑-垂体-肾上腺轴的功能,但无明显的临床意义。吸入型糖皮质激素在短期内抑制了患儿的生长速度,但整体影响小,且不会持续不变。骨质疏松、骨折的发生与吸入型糖皮质激素在高剂量时有明显的剂量依赖关系。     

Activity of medullary respiratory neurones during reflexes from the lungs in cats.

We have studied in cats the discharge pattern in response to lung inflation and deflation of 283 medullary respiratory neurones, 173 being inspiratory and 110 expiratory. The ventral respiratory nucleus, near the nucleus ambiguus, was particularly investigated. The neurones were classified into bulbo-spinal neurones, laryngeal motoneurones and propriobulbar neurones by antidromic invasion from the spinal cord or the vagus nerve (collision test). The bulbo-spinal neurones responded in the same direction as spinal motoneurones in the Hering-Breuer reflexes: depression of inspiratory neurones and facilitation of expiratory neurones by inflation of the lungs. All the expiratory laryngeal motoneurones and some inspiratory laryngeal motoneurons responded in the opposite direction to the Hering-Breuer reflexes: depression of expiratory motoneurones and facilitation of inspiratory motoneurones. The function of propriobular neurones could be inferred from their response to Hering-Breuer reflexes: one group of propriobulbar neurones responded in such a manner as to be linked to the activity of the bulbo-spinal neurones; the other group responded in accordance with the activity of the laryngeal motoneurones.     

Exercise training in cardiac patients: usefulness of the cardiopulmonary exercise test

Exercise training is currently including in the treatment of coronary arterial disease patients, in patients with left ventricular dysfunction as well as in patients who underwent cardiac transplantation or cardiac surgery. However methods of prescribing exercise-training programs are difficult to determine and must be adapted for each patient Exercise test with gas analysis through the determination of anaerobic threshold may help to understand the physiopathological mechanism related to exercise limitation in these patients. Exercise test may help to precise exercise intensity during cardiac rehabilitation and may assess the benefits on exercise tolerance.     

Effects of inhaled corticosteroids and inhaled cromolyn sodium on urinary growth hormone excretion in asthmatic children

Over the past few years there has been an increasing awareness that asthma is a chronic inflammatory airways disease. The current therapeutic strategies for treating asthma focus on suppressing the inflammatory process by using cromones or inhaled corticosteroids (ICS). The beneficial effects of ICS in asthma are now well known, but its detrimental effect on linear growth remains a controversial issue. The aim of this open label, nonrandomized, cross-sectional, one-time study was to determine the influence of these drugs on urinary growth hormone (U-GH) levels in prepubertal asthmatic children. U-GH levels were measured in 47 prepubertal asthmatic children who had been treated for at least 6 months with either ICS (beclomethasone or budesonide at a mean daily dose of 360 μg) or with 80 mg daily dose of cromolyn sodium (CrS). There were also nine healthy children who served as a control. These three groups of children were matched for age and gender ratio. The mean level of U-GH in the CrS-treated group was 2.94 ± 0.96 ng/night; this was significantly higher compared to the mean level of the ICS-treated group (1.99 ± 0.83 ng/night; P < 0.001) and to the mean level of the control group (1.98 ± 0.39 ng/night; P < 0.006). There was no significant difference between the mean level of U-GH in the group treated by ICS and the controls (P < 0.9). These results show that the mean levels of U-GH secretion of the children who were treated by CrS for 6 months was significantly increased, compared to the mean U-GH level of the ICS-treated group and the controls. The mean U-GH levels in the last two groups showed no statistically significant difference. Pediatr Pulmonol. 1998; 26:339–343. © 1998 Wiley-Liss, Inc.     

Effects of different corticosteroids on the development of osteonecrosis in rabbits

OBJECTIVES: Osteonecrosis (ON) of the femoral head is a devastating complication occurring in patients receiving corticosteroid treatment. This study examined the effect of three corticosteroids on the development of ON in rabbits. METHODS: Thirty-nine rabbits were injected once intramuscularly with either 25 mg/kg prednisolone sodium succinate (PSL; 13 rabbits), 20 mg/kg methylprednisolone acetate (MPSL; 13 rabbits) or 20 mg/kg triamcinolone acetonide (TR; 13 rabbits). Four weeks after corticosteroid injection, the bilateral femora and humeri were examined histopathologically for the presence of ON. Haematological examinations were performed before and after corticosteroid injection. RESULTS: MPSL treatment (17/26 proximal femora, 65%) significantly increased ON incidence in the proximal femora compared with the levels seen after TR (4/26, 15%) or PSL (3/26, 12%) treatment (P < 0.01). Although not significantly increased in comparison with rabbits receiving PSL treatment (1/26 proximal humeri, 4%), ON incidence within the proximal humeri was significantly increased in MPSL-treated rabbits (6/26, 23%) in comparison with those seen in rabbits receiving TR (0/26, 0%) treatment (P < 0.05). Serum levels of cholesterol, triglyceride and free fatty acid were significantly higher 1, 2 and 4 weeks after corticosteroid treatment in rabbits treated with MPSL relative to rabbits receiving TR and rabbits with PSL treatment (P < 0.05). CONCLUSIONS: MPSL treatment significantly increased ON incidence in rabbits over levels seen after TR or PSL treatment.     

Dose effects of corticosteroids on the development of osteonecrosis in rabbits

OBJECTIVE: The relationship between dose of corticosteroids and the prevalence of osteonecrosis (ON) has not been established. We examined the dose effects of corticosteroids on the development of ON in a rabbit model. METHODS: Rabbits were injected once intramuscularly with 1 (12 rabbits), 5 (12 rabbits), 20 (20 rabbits), and 40 (25 rabbits) mg/kg of methylprednisolone acetate (MPSL) into the right gluteus medius muscle. Four weeks after the MPSL injection, the proximal and distal parts of both the femora and humeri were histopathologically examined for the presence of ON. Hematological examinations were performed before and after the corticosteroid injection. RESULTS: In rabbits with 1, 5, 20, and 40 mg/kg MPSL, the incidence of ON was 0, 42%, 70%, and 96%, respectively. The dose of MPSL showed a significant association with the incidence of ON. Histologically, reparative tissues around the ON sites were observed in the rabbits with 5 mg/kg MPSL, but not observed in rabbits with 20 and 40 mg/kg MPSL. On hematological examination, hyperlipidemia and thrombocytopenia were most apparent in the rabbits receiving 40 mg/kg MPSL. CONCLUSION: The study suggested that the dose of corticosteroids plays an important role in the development of ON in rabbits. The repair process was also found to be influenced by the dose of corticosteroids. Corticosteroid-induced hyperlipidemia and thrombocytopenia seemed to be associated with the incidence of ON.     

Influence of inhaled corticosteroids on community-acquired pneumonia in patients with bronchial asthma

OBJECTIVE: The aim of the present study was to evaluate the influence of inhaled corticosteroids (ICS) on community-acquired pneumonia (CAP) in patients with asthma. PATIENTS AND METHODS: All asthmatic patients who required hospitalization for CAP from the beginning of 1989 through December 2001 were enrolled in this retrospective study. Patients who used oral corticosteroids daily were excluded. Patients were divided into two groups based on whether or not they used ICS, and we analyzed clinical characteristics of the pneumonia. Sixty-two patients (28 males, 34 females; mean age, 54.5 years) were enrolled in this study. Thirty-seven of 62 patients used ICS, with the mean dosage being 777.9 microg/day. RESULTS: We found no significant differences between the two groups with regard to mean age, serum albumin level, duration of asthma, pulmonary function and frequency of intravenous infusion of corticosteroids in the outpatient department. There were no significant differences in body temperature, white blood cell count, and CRP value upon admission between the two groups. Differences were not significant in the period of resolution of the pneumonia or in the frequency of pathogens identified between the two groups. CONCLUSION: ICS therapy appears to have no influence on CAP in patients with asthma. We recommend that ICS should be continued to control asthma with adequate antibiotic therapy when asthmatic patients have CAP.     

Influence of dentures on residual inhaled corticosteroids in the mouths of elderly asthma patients

BackgroundThe influence of dentures on residual inhaled corticosteroids (ICSs) in the mouths of elderly asthmatic patients and the appropriate time for gargling after inhaling ICSs are unclear.MethodsTwenty elderly patients in whom moderate persistent asthma was stably controlled using fluticasone propionate Diskus^® (FP, n=10) or hydrofluoroalkane-beclomethasone dipropionate (HFA-BDP, n=10) for more than 3 months and who wore dentures daily were switched to the other type of ICS for 4 weeks in a crossover manner. The residual amount of each ICS in their mouths after inhalation was measured along with determination of peak inspiratory flow (PIF) and pharyngeal culture for detecting Candida albicans.ResultsThe total amounts of residual ICSs in gargling fluids (μg) with HFA-BDP were significantly greater than those with FP (15.6±14.6 vs. 11.5±13.8, p=0.028). The residual amounts of HFA-BDP were significantly greater in the patients with complete dentures than in those with partial dentures. The residual amounts of FP were significantly correlated with the PIF values in the FP treatment (p=0.013) but not in the HFA-BDP treatment (p=0.202). No residual ICSs remained after the third gargling in either treatment. The occurrence of candidiasis during the HFA-BDP period was significantly higher than that during the FP treatment (p=0.046).ConclusionThe dentures of elderly asthmatics affect the oral residues of ICSs and occurrence of candidiasis in HFA-BDP treatment; meanwhile, the PIF values affected these factors in FP treatment. Three times gargling after inhaling ICSs is required.     

Effects of inhaled corticosteroids on cough threshold in patients with bronchial asthma

In asthmatic subjects cough can be related to the degree of airway inflammation. The aim of this study was to evaluate the effect of treatment with high dose inhaled beclomethasone dipropionate (BDP) on cough threshold in asthmatic subjects. Cough threshold to inhaled capsaicin (one breath of 10(-8)-10(-4)M solution) and to citric acid (one breath of 10(-4)-1 M), expressed as provocative concentration of two (PC2) and four coughs (PC4), was measured in 16 normal and 36 asthmatic subjects. After baseline evaluation, asthmatic subjects were randomized in two groups: (a) Group A, n=20: treated with salbutamol (200 microg t.i.d.) plus BDP (500 microg t.i.d.); (b) Group B, n=16: treated with salbutamol plus placebo in the same doses. After 1 month, cough threshold and clinical and functional evaluation were repeated. After treatment, asthmatics of group A showed a significant improvement in PC4 citric acid, in total symptom and cough scores, and in PD20FEV1 methacholine. In asthmatics of group B, treatment caused no improvement in symptoms, PD20FEV1 methacoline and cough threshold. In addition, cough threshold was not different between normal and asthmatic subjects and, in asthmatics, cough threshold did not correlate with PD20FEV1 methacholine. These data confirm that cough in asthma can be partially related to airway inflammation.