小量吸入布地乃德对支气管哮喘的疗效

目的研究小剂量吸入激素合用茶碱对中度哮喘患者症状、肺功能的影响。方法通过4周较大剂量(布地乃德BUD400ug bid)治疗,66例中度哮喘患者随机分为3组,包括A组吸入BUD300μg bid;B组BUD100μg bid;C组BUD100μg bid并加用茶碱缓释片200mg口服每天2次,以上治疗共6月。结果4周大剂量基础治疗后,患者症状明显缓解、肺功能明显改善,并且在以后4个月的治疗研究阶段患者多较稳定,只有少数急性发作,急性发作次数或天数,C组少于B组(P<0.05),各组患者肺功能进一步好转,但B组肺功能变化与基础治疗后比较差异不显著。结论大剂量BUD吸入对中度哮喘具有良好的治疗效果,在稳定阶段给予小剂量BUD加用茶硷似有更好疗效。     

皮质类固醇吸入治疗支气管哮喘疗效观察

目的 观察皮质类固醇吸入疗法对轻、中度持续哮喘患者的疗效及药物对人体的影响。方法 将120例轻、中度持续哮喘患者随机分为A、B、C、D四组。四组均按需使用吸入型β_2-肾上腺素能受体激动剂万托林,其中A、B、C组分别吸入皮质类固醇二丙酸倍氯米松(BDP)200、400和800μg/d;D组(对照组)不使用激素治疗。总疗程为6个月。观察治疗前后日间哮喘症状评分、夜间憋醒次数、万托林吸入次数,测1秒钟用力呼气容积(FEV_1)、骨密度(BMD)、血清嗜酸细胞阳离子蛋白(ECP)及皮质醇(Cortisol),并进行比较。结果 治疗后,四组日间哮喘症状评分、夜间喘憋次数均明显低于治疗前;万托林吸入次数A、B、C组明显少于治疗前,其中尤以B、C两组为著(P<0.001);A、B、C三组FEV_1明显提高,ECP明显降低,尤以B、C两组为著(P0.05)。A、B、D组治疗前后Cortisol和BMD无明显变化(P>0.05);C组BMD下降,且有统计学意义。结论 吸入BDP400μg/d治疗轻、中度持续哮喘具有减轻临床症状,改善肺功能及抗炎作用,且对肾上腺皮质轴及BMD无影响。     

丙酸培氯米松定量雾化吸入对支气管哮喘的治疗作用

目的观察丙酸培氯米松雾化吸入对支气管哮喘患者的治疗作用。方法将31例患者随机分成丙酸培氯米松治疗组(A组)和沙丁胺醇治疗组(B组),A组吸入丙酸培氯米松雾化剂,每日二次,每次400μg;B组吸入沙丁胺醇雾化剂,每日二次,每次200μg。二组疗程均为一月,分别检查治疗前后的肺功能指标。结果治疗后,A组肺功能有显著增加,B组肺功能无明显变化。结论吸入糖皮质激素治疗哮喘,疗效可靠,副作用少,值得推广;吸入B2受体激动剂可改善哮喘症状,但不提倡规律或频繁地使用。     

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。     

吸入皮质激素与茶碱控释剂或β_2激动剂长期联合治疗慢性中度哮喘的研究

目的　观察在吸入皮质激素的基础上联合茶碱控释剂或 β2 激动剂对慢性中度哮喘病人的治疗作用。方法　 99例慢性中度哮喘病人随机分为吸入丙酸培氯松 口服茶碱控释剂组 (T组 )和吸入丙酸培氯松加口服β2 激动剂组 (C组 ) ,疗程均为 8周。记录每日哮喘发作次数、症状评分和测定PEF ;治疗前和每治疗 2周后测定FVC、FEV1。结果　两组病人症状评分、发作次数以及肺功能在治疗后均出现明显改善 ,但两组间无明显差异。比较用药后第 4、6、8周PEF变异率较用药第 1周降低的差值 (△PEF)时 ,发现第 6和 8周T组△PEF明显大于C组。结论　在吸入皮质激素基础上 ,联合应用氨茶碱缓释剂或 β2 激动剂对慢性中度哮喘病人临床症状、肺功能均有明显改善作用。吸入皮质激素联合应用茶碱控释剂对PEF变异率降低幅度大于联合应用 β2 激动剂。     

白三烯拮抗剂联合吸入糖皮质激素治疗慢性中度持续支气管哮喘的临床疗效观察

目的评价白三烯拮抗剂联合吸入糖皮质激素对慢性中度持续支气管哮喘患者肺功能及疗效的影响。方法选取我院2010年2月~2013年1月收治的60例慢性中度持续支气管哮喘患者,按照随机数字表法随机分为治疗组与对照组各30例,对照组给予氟替卡松气雾剂吸入200μg,1次/d;治疗组在对照组基础上加用孟鲁司特钠咀嚼片,10 mg口服,1次/d。两组患者疗程均为4周。结果治疗4周后两组患者各项肺功能指标均较治疗前明显改善(P0.05),但同期比较治疗组较对照组改善更为明显(P0.05),治疗组总有效率显著高于对照组(χ2=15.427,P0.01)。结论白三烯拮抗剂联合吸入糖皮质激素可显著缓解临床症状及体征、改善肺功能指标,且安全性较高。     

噻托溴铵联合布地奈德治疗轻中度哮喘的临床疗效评价

目的 观察噻托溴铵联合吸人糖皮质激素对轻中度哮喘患者的临床疗效.方法 60例轻中度哮喘患者随机分为两组:噻托溴铵组给予吸入噻托溴铵干粉剂(18μg,每日1次)与布地奈德干粉剂(200 μg,每日2次);福莫特罗组给予吸入布地奈德福莫特罗干粉剂(160/4.5 μg,每日2次).在治疗前及治疗后8 w测定两组症状体征及肺功能变化.结果 治疗后8w,噻托溴铵组及福莫特罗组患者症状体征评分和肺功能指标明显改善,两组间比较,差异无统计学意义(P＞0.05).结论 在吸入糖皮质激素的基础上加用噻托溴铵,可明显改善轻中度哮喘患者的症状和肺功能,其疗效和加用福莫特罗相当.     

扎鲁司特对治疗哮喘减少吸入激素剂量的评价

目的 评价重度慢性哮喘患者在减少吸入激素剂量期间加服扎鲁司特的临床疗效。方法 34例接受高剂量吸入激素治疗的重度慢性哮喘患者随机分为两组：扎鲁司特组和对照组。观察吸入激素剂量减半同时加口服扎鲁司特后肺功能（FEV1与PEFR）和每周按需使用β2激动剂的次数明显增多。结论 激素减量吸入同时加服扎鲁司特并不引起哮喘病情的恶化,扎鲁司特对吸入激素有一定替代作用。     

沙美特罗／丙酸氟替卡松治疗哮喘的临床疗效观察

目的比较沙美特罗／氟替卡松复方制剂舒利迭（SFC）与单用吸入糖皮质激素（ms）布地奈德粉吸入剂治疗哮喘的疗效。方法50例成年轻中度哮喘患者分为两组：①SFC组（32例）使用SFC50／250P,g,吸入,每日2次,治疗4周;②ICS组（18例）,每次400μg布地奈德粉吸入剂,每日2次,治疗4周。观察哮喘习间症状评分、夜间憋醒次数及最大呼气流速（PEF）的变化。结果治疗后SFC组平均症状缓解时间为3d,而ICS组为9d（P〈0.01）。治疗4周SFC组哮喘日间症状评分减少2分,ICS组减少1分（P〈0.05）,夜间憋醒次数两组分别减少1次,0次（P〈0.05）;治疗4周肺功能有效率SFC组和ICS组分别为71％、46％（P〈0.05）。结论改善轻中度哮喘患者的症状及肺功能,SFC相比于单用ICS更快、更有效。     

舒利迭治疗支气管哮喘30例临床疗效分析

目的观察舒利迭（沙美特罗氟替卡松粉吸入剂）治疗支气管哮喘的临床疗效。方法30例确诊为支气管哮喘轻、中度发作的患者予舒利迭50ug／100ug吸／次，每日两次，经准纳器吸入，共用4周．观察吸入前后临床症状变化，药物反应及肺功能（FEV1.0（第一秒用力呼气容积），FVC（用力呼气肺活量），PEFR（用力呼气峰流速）]。结果舒利迭治疗支气管哮喘症状计分及肺功能较治疗前明显改善（P〈0．01）。结论吸入舒利迭治疗支气管哮喘有较好的临床疗效。     

Low-dose budesonide with the addition of an increased dose during exacerbations is effective in long-term asthma control. On behalf of the Italian Study Group

OBJECTIVES: This study was designed to compare the effects of a 6-month treatment with budesonide 100 microg bid (low dose) and 400 microg bid (standard reference dose) in controlling symptoms and lung function in a group of asthmatics with moderate asthma (baseline FEV(1) > or = 50% and < or = 90% of predicted values) previously treated with inhaled beclomethasone dipropionate (500 to 1,000 microg/d). Moreover, we investigated whether or not asthma exacerbations could be treated by a short-term increase in the daily dose of budesonide. METHODS: After a 2-week run-in period and 1-month treatment with a high dose of budesonide (800 microg bid), 213 patients with moderate asthma were assigned to randomized treatments. Daily treatment included budesonide (bid) plus an additional treatment in case of exacerbation (qid for 7 days). Treatments were as follows: budesonide 400 microg plus placebo (group 1); budesonide 100 microg plus budesonide 200 microg (group 2); and budesonide 100 microg plus placebo (group 3). Symptoms and a peak expiratory flow (PEF) diary were recorded and lung function was measured each month. An exacerbation was defined as a decrease in PEF > 30% below baseline values on 2 consecutive days. RESULTS: We found that that 1-month treatment with a high budesonide dose remarkably reduced all asthma symptoms. Moreover, symptoms were under control in all treatment groups throughout the study period. Similarly, lung function improved and remained stable, and no relevant differences between groups were observed. In each treatment group, the majority of patients had no exacerbations. In patients treated with the standard budesonide dose (group 1), the number of exacerbations and days with exacerbations were significantly lower than in group 3 (intention-to-treat analysis). Additionally, patients treated with low budesonide dose plus budesonide (group 2) experienced a significantly lower number of exacerbations and days with exacerbations compared to group 3 (per-protocol analysis). CONCLUSIONS: This study demonstrates that when patients with moderate asthma had reached a stable clinical condition with a high dose of budesonide, a low dose of budesonide (200 microg/d) is as effective as the standard dose (800 microg/d) in the control of symptoms and lung function over a period of several months. Furthermore, results showed that the addition of inhaled budesonide (800 microg/d) at onset of an asthmatic exacerbation has a beneficial clinical effect.     

Equivalent efficacy and safety of a new HFA-134a formulation of BDP compared with the conventional CFC in adult asthmatics.

The present study demonstrates the equivalent efficacy for BDP 500 microg bid given via MDI with the new HFA-134a propellant (Chiesi Farmaceutici S.p.A., Parma) compared to a conventional CFC propellant (Becotide, Allen & Hanburys, UK). One hundred and sixteen adult patients with stable mild to moderate asthma (FEV1 > or = 60% of predicted normal) entered a 2-week run-in period where they maintained their own inhaled corticosteroids and were then assigned to a 12-week treatment with the test drug in a randomized, multicentre, double-blind, double-dummy, parallel-group design. Ninety-one patients completed the study period. Morning and evening peak expiratory flow rate (PEFR), use of rescue salbutamol, number of daytime and nighttime asthma attacks, number of nighttime awakenings, and clinical symptoms were recorded daily by patients on a diary card. Pulmonary function tests (FEV1, FVC, PEFR, MEF50 and FEF25) were completed at study entry, at the start of treatment and every 2 weeks thereafter. Morning (08.00-10.00 AM) serum cortisol was measured at the start and at the end of treatment. Adverse events were collected for the total study period. Equivalence between groups was demonstrated for the primary end-point morning PEFR, as well as for evening PEFR and FEV1 (the 95% CI of the treatments' difference was within the 5% of the LSM of BDP CFC). The other secondary pulmonary function tests measured at the clinic visit showed a satisfactory asthma control, albeit without statistically significant differences between groups. Decreases in the use of rescue salbutamol and in clinical symptoms were also reported in both groups, with no differences between them. Adverse events were reported in 81.4% of patients in the BDP HFA group and in 82.5% in the CFC group. There were 73 and 59 adverse drug reactions in the two groups, respectively; the difference was mainly due to differences in taste. No drug-related serious adverse events were reported in either group. No difference was seen for morning serum cortisol between baseline and end of treatment, or between groups. In conclusion, the BDP-HFA 134a formulation proved to be statistically equivalent to the standard BDP CFC product over 12 weeks in adult patients with mild to moderate asthma.     

Evaluation of factors that allow the clinician to taper inhaled corticosteroids in childhood asthma

Inhaled corticosteroids are potent and effective treatment agents for controlling symptoms of childhood asthma. However, there are no predictive factors that help to determine which patients with asthma are likely to be tapered off inhaled corticosteroids successfully. We examined whether any factor or combination of factors could help the clinician safely discontinue inhaled steroid therapy. Thirty-six asthmatic children whose symptoms were stable on low-dose beclomethasone dipropionate (BDP) were divided by parental choice into two groups: maintenance BDP (n = 11) and no BDP (n = 25). Methacholine inhalation tests were performed at the beginning of the study and after 1 month. Twelve children (48%) who had BDP discontinued developed exacerbations after 2–3 months, whereas there were no problems in the maintenance group. The no BDP group was retrospectively divided into two subgroups: exacerbation (+) and (−). The threshold to methacholine in the exacerbation (+) subgroup decreased significantly in advance of clinical symptoms. The two subgroups were analyzed statistically by two-group discriminant function analysis. The change in threshold to methacholine, the dose and potency of drugs, duration of asthma and gender (female) correlated with exacerbation. These results suggest that discontinuation of inhaled steroids should be done carefully, even in stable asthmatic children. The methacholine inhalation test, gender, drugs and history may be used as references for discontinuing inhaled steroids.     

Inhaled corticosteroids reduce the severity of bronchial hyperresponsiveness in asthma but oral theophylline does not

In a double-blind crossover study, we compared the relative effects of inhaled beclomethasone dipropionate (BDP) 800 micrograms per day and oral theophylline on the severity of bronchial hyperresponsiveness (BHR) to histamine. Daily doses of theophylline were sufficient to keep serum levels between 55 and 110 mumol/L. The subjects were 26 patients with severe asthma whose symptoms were inadequately controlled by regular treatment with inhaled salbutamol. The severity of BHR improved within 3 wk in the group treated with BDP, whereas no change occurred in the group treated with theophylline. There were no significant changes in FEV1 in either group during the study. When BDP was changed to theophylline there was a deterioration in BHR. Aerosol steroids, rather than theophylline, are the treatment of choice when reduction in the severity of BHR is the aim of treatment in patients with severe asthma.     

High doses of inhaled corticosteroids in unstable chronic asthma. A multicenter, double-blind, placebo-controlled study

In a multicenter, randomized, double-blind study, inhaled beclomethasone dipropionate (BDP) 1,500 micrograms/day was compared to placebo in 43 chronic asthmatic patients uncontrolled by inhaled salbutamol and oral theophylline. During the prestudy period, a test of maximal steroid reversibility with oral prednisolone 0.5 mg/kg/day for 14 days was performed. The therapeutic response was measured over an 8-wk period as the ability to maintain the clinical improvement and the optimal pulmonary function induced by prednisolone. During the study, severe asthma exacerbation occurred in one (5%) of the 21 patients who received BDP and in 15 (78%) of the 22 patients who received placebo (p less than 0.001). In patients who received BDP, FEV1 and peak expiratory flow (PEF) remained above the optimal postprednisolone value, with a trend to improvement during the 8-wk study period. In patients who received placebo, FEV1 and PEF decreased and remained below the optimal value. We conclude that, in chronic asthma, inhaled BDP 1,500 micrograms/day maintains the optimal pulmonary function in addition to the clinical benefit induced by a short course of oral corticosteroids.     

Double-blind, randomised, controlled trial assessing controller medications in asthma

BACKGROUND: The motive behind conducting this study was to determine if better control of asthma can be achieved by adding a second controller medication and to assess its use to reduce the dose of inhaled steroids. OBJECTIVES: The study aimed to determine whether either oral sustained-release theophylline or montelukast added to inhaled steroids improved clinical symptoms and pulmonary function test parameters when compared to high-dose steroids alone. METHODS: Ninety patients with incompletely controlled asthma were allocated, in a randomised, double-blind fashion, to one of three treatment groups: group A: double dose of inhaled budesonide (400 microg b.i.d.), group B: 400 mg oral sustained-release theophylline plus budesonide (200 microg b.i.d.) and group C: 10 mg montelukast plus budesonide (200 microg b.i.d.). The primary endpoints were forced expiratory volume in 1 s (FEV(1)) and mean morning peak expiratory flow rate (PEFR). RESULTS: All three groups had improved FEV(1) and PEFR at 8 weeks (p < 0.001). Group C increased their PEFR by 18.7 l/min (95% confidence interval, CI, 12.4-25.1) more than group A and by 19.8 l/min (95% CI 13.4-26.1) more than group B (both p = 0.001). Similarly, group C had a 114 ml (95% CI 45-183 ml) greater improvement in FEV(1) than group A and a 95 ml (95% CI 26-164 ml) greater improvement than group B (both p = 0.01). CONCLUSIONS: Addition of montelukast to budesonide is safe and results in greater improvement in pulmonary function test parameters than high-dose budesonide treatment or addition of theophylline.     

福多司坦联合小剂量吸入性激素治疗支气管哮喘的临床研究

目的观察福多司坦联合小剂量吸入性糖皮质激素治疗轻中度哮喘的临床效果。方法将40例哮喘患者随机分为两组,实验组给与福多司坦联合小剂量二丙酸倍氯米松气雾剂,对照组给予大剂量二丙酸倍氯米松气雾剂。治疗前后评价PEFRv、FEVl%及不良反应。同时检测治疗前后诱导痰上清中IL-8含量的变化。结果福多司坦联合小剂量吸入性激素治疗轻、中度哮喘可显著降低PEFRv及提高FEVl%(P<0.05),两组间PEFRv改善百分比和FEVl%改善百分比均无明显统计学差异(P>0.05)。两组均可明显降低哮喘患者的诱导痰上清中IL-8的水平。结论小剂量吸入性激素联合福多司坦和大剂量吸入性激素对治疗轻中度哮喘的疗效相当。     

Evaluation of theophylline or pranlukast, a cysteinyl leukotriene receptor 1 antagonist, as add-on therapy in uncontrolled asthmatic patients with a medium dose of inhaled corticosteroids.

A few studies compared the additional effects of oral controller medicines on pulmonary function in asthmatic patients on a moderate dose of inhaled steroids. The aim of this study was to compare the additional effects of two oral asthma controllers, a leukotriene receptor antagonist and a sustained released theophylline (Theo), with a moderate dose of inhaled steroid on peak expiratory flow (PEF) and asthma-related symptoms. A total of 67 adult asthmatic patients with PEF < 80% predicted during a 2-week run-in period with 800 microg/day of beclomethasone dipropionate were randomized to receive either pranlukast, 450 mg/day (n = 33), or sustained released Theo, 200 mg/day (n = 34), for 4 weeks. Pranlukast and Theo did not significantly alter the symptom scores, use of rescue beta2-agonist, and daily PEF variability. However, both agents significantly increased both morning and evening PEF compared with the run-in periods. The effects of both medications were comparable. For asthmatic patients even on a moderate dose of inhaled steroids, the addition of either leukotriene receptor antagonist or sustained released Theo does not improve asthma-related symptoms but significantly and equally increases PEF.