吸入性糖皮质激素对支气管哮喘患者肺炎风险的荟萃分析

目的:研究吸入性糖皮质激素(ICS)治疗与支气管哮喘(哮喘)患者肺炎风险之间的关系。方法:检索PubMed、Embase、Cochrane library、维普数据、万方数据、中国知网数据库,截至2020年5月发表的比较使用和不使用ICS治疗的哮喘患者罹患肺炎风险的随机对照试验。数据由两人单独提取。使用Review M...     

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     

吸烟对支气管哮喘患者糖皮质激素疗效的影响

选择第3、4级支气管哮喘患者65例,按吸烟史分为吸烟组和非吸烟组,给予甲基强的松龙治疗,住院当日及2周后分别留取患者血清检测其细胞因子水平及肺功能等指标,同时判定其临床疗效.发现糖皮质激素治疗后哮喘患者IL-6下调,IL-2、IL-8和TNF-α均明显下调,IL-10明显上调;吸烟组IL-8和TNF-α水平明显高于非吸烟组;两组治疗后的肺功能指标较治疗前明显改善.非吸烟组日间及夜间症状评分较治疗前改善明显.提示非吸烟的哮喘患者应用糖皮质激素的疗效优于吸烟的哮喘患者.     

吸入糖皮质激素联合茶碱对未控制吸烟支气管哮喘患者的临床研究

目的观察小剂量吸入糖皮质激素（inhaledcorticosteroids,ICS）联合小剂量茶碱对未控制吸烟支气管哮喘（简称哮喘）患者的治疗效果。方法筛选门诊未控制吸烟哮喘患者80例,随机分为试验组和对照组,试验组为吸烟患者,对照组为不吸烟患者。两组每日吸入布地奈德,每吸200μg,每天2吸,联合口服氨茶碱片0．1g,每天3次,疗程3个月。比较治疗前后的哮喘控制测试（asthmacontroltest,ACT）评分,呼气峰流速（peakexpiratoryflow,PEF）,第1秒用力呼气容积占预计值百分比（FEVl％pred）,外周静脉血IL-4、IL-5、IgE值的变化。结果两组治疗前、治疗3个月后的ACT评分、PEF、FEVl％pred、IL-4、IL-5、IgE值：试验组分别为：（14．3±2．4）和（21．7±2．0）,（255．9±99．7）L／min和（290．3±105．2）L／min,（66．5±4．7）和（72．9±5．4）,（14．5±3．2）ng／L和（12．3±3．4）ng／L,（27．2±6．4）ng／L和（24．2±5．8）ng／L,（82．7±16．8）IU／ml和（67．1±14．3）Iu／m1,对照组分别为：（13．8±2．2）和（21．5±1．4）,（279．1±103．3）L／rain和（321．3±110．4）L／min,（68．8±5．8）和（74．8±5．5）,（13．4±2．9）ng／L和（11．4±2．8）ng／L,（26．54-6．9）ng／L和（22．8±6．2）ng／L,（78．8±18．2）IU／ml和（66．4±17．8）IU／ml,两组组内比较差异有统计学意义（P〈O．05）,组间比较差异无统计学意义（P〉0．05）。结论小剂量ICS联合小剂量茶碱,在改善吸烟哮喘患者症状、提高肺功能、控制气道炎症方面与不吸烟患者有相同的疗效。     

长期吸入糖皮质激素对哮喘患者某些骨代谢指标的影响

目的 了解南京地区哮喘患长期吸入类固醇糖皮质激素（GCS）是否会引起骨质丢失。方法 采用双能X线骨密度仪（DEXA）和放免法等分别测定20例每日坚持吸GCS大于等于五个月的哮喘患的骨密度（BMD）、血骨钙素（BGP）等指标,并同期配对20例未使用GCS的哮喘患进行对比分析。结果 显示两组病人BMD和BGP等各指标之间无显差异,P＞0．05。结论 在一定限度内长期吸入GCS控制哮喘,对骨代谢不产生明显影响。     

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。     

支气管哮喘患者吸入性糖皮质激素疗效与基因多态性研究进展

支气管哮喘(简称哮喘)是一种多基因疾病。吸入性糖皮质激素是哮喘治疗的一线药物,但哮喘患者吸入性糖皮质激素的疗效则各有不同,本文就哮喘患者吸入性糖皮质激素疗效与基因多态性关系的研究进展作一综述。     

吸烟对支气管哮喘的影响

吸烟与支气管哮喘(简称哮喘)关系密切,吸烟可导致哮喘的发生,发展.吸烟哮喘患者在气道炎症,临症状和治疗等方面均与非吸烟哮喘患者有差异.本文旨在讨论吸烟对哮喘的影响.     

吸入性糖皮质激素增加哮喘患者肺炎风险

目的 探讨哮喘患者长期吸入激素(ICS)是否增加肺炎发生风险.方法 选择上海市杨浦区市东医院07年1月～ 07年12月哮喘患者共300例,其中使用ICS者156例(A组),未使用者144例(B组),并选择同期健康志愿者150例(C组).结果 随访6、12、18、24个月结束时,A组患者ICS使用总量分别为28.50 g、50.10 g、61.30 g、69.10 g,发生肺炎分别为10、23、37、53例次；B组发生肺炎分别为7、14、22、29例次；C组发生肺炎分别为9、16、26、33例次.B组和C组比较差异无统计学意义(P＞0.05).A组和B组、C组比较差异有统计学意义(P＜0.05).结论 长期使用ICS增加肺炎风险,随着剂量和时间增加,肺炎发病机会增高,但预后良好.     

Addition to inhaled corticosteroids of leukotriene receptor antagonists versus theophylline for symptomatic asthma: a meta-analysis

Background

Inhaled corticosteroids (ICSs) are widely used in combination with second controller medications in the management of asthma in adults and children. There lacks a systematic comparison between addition of leukotriene receptor antagonists (LTRAs) and theophylline to ICS. The purpose of this meta-analysis was to evaluate the difference of the efficacy and safety profile of adding either LTRAs or theophylline to ICS in adults and children with symptomatic asthma.

Methods

Randomised controlled trials (RCTs) published prior to November 2014 were acquired through systematically searching and selected based on the established inclusion criteria for publications. The data extracted from the included studies were further analyzed by a meta-analysis.

Results

We included eight RCTs, of which six recruited adults and two recruited children aged 5 to 14 years. The primary outcomes were changes in lung function from baseline, including forced expiratory volume in the first second (FEV₁) and peak expiratory flow (PEF). Overall, addition of LTRAs led to significantly better morning PEF {mean difference (MD) 16.94 [95% confidence interval (CI): 11.49-22.39] L/min, P<0.01} and FEV₁ [MD 0.09 (95% CI: 0.03-0.15) L, P=0.005] as compared to addition of theophylline. There were no differences between the two treatments in terms of evening PEF, adverse events, rescue medication use and asthma exacerbation.

Conclusions

The combination of LTRA and ICS leads to modestly greater improvement in lung function than the combination of theophylline and ICS in the treatment of symptomatic asthma. Long-term trials are required to assess the efficacy and safety of these two therapies.     

哮喘儿童持续吸入低剂量糖皮质激素的全身性副作用

目的 探讨我国哮喘儿童吸入糖皮质激素的全身性副作用.方法 将30例14岁以下轻度哮喘儿童随机分为安慰剂组(A组)、二丙酸倍氯松(BDP)200 μg组(B组)、BDP 400 μg组(C组),每组10例,分别持续吸入安慰剂及BDP 200、400 μg/d 1年,观察患儿气道高反应性(BHR)、身高增长、骨密度(BMD)、钙磷代谢及下丘脑-垂体-肾上腺轴(HPAA)功能的影响.结果 B组及C组患儿吸入BDP后PD20-FEV1即一秒钟用力呼气容积下降20% 时累积吸入的组胺剂量[Log(PD20- FEV1)]分别为(2.70±0.13) μg及(3.15±0.18) μg,与治疗前[B组(2.04±0.47) μg,C组(1.94±0.46) μg]比较,差异有显著性(P均<0.01),而B组与C组间比较,差异有显著性(P<0.01).A、B及C组患儿吸入BDP后血骨钙素分别为(29±12) μg/L、(22±6) μg/L、(31±11) μg/L,血钙为(2.49±0.11) mmol/L、(2.39±0.28) mmol/L、(2.20±0.35) mmol/L, 血磷为(1.8±0.6) mmol/L、(1.7±0.7) mmol/L、(1.5±0.4) mmol/L,血碱性磷酸酶为(410±113) U/L、(337±99) U/L、(351±122) U/L(P>0.05),桡骨BMD为(0.40±0.10) g/cm2、(0.42±0.05 ) g/cm2、(0.44±0.02) g/cm2,尺骨BMD为(0.32±0.07) g/cm2、(0.36±0.08) g/cm2、(0.35±0.04) g/cm2,腰椎4～5BMD为(0.62±0.09) g/cm2、(0.59±0.08) g/cm2、(0.64±0.06) g/cm2,血皮质醇基础值为(350±86)nmol/L、(407±199) nmol/L、(365±71)nmol/L, 三组间比较差异无显著性(P均>0.05).但C组治疗后血皮质醇对促肾上腺皮质激素(ACTH)刺激的反应值为(482±97) nmol/L, 与治疗前(621±199 )nmol/L比较,差异有显著性(P<0.01),而A组和B组治疗后分别为 (566±203) nmol/L,(452±97)nmol/L,与治疗前[A组(534±204)nmol/L,B组(481±82)nmol/L]比较,差异无显著性(P均>0.05).A组患儿吸入BDP后身高标准差计分(SDS)为(1.2±0.9)分,B组为(1.3±0.9)分,C组为(1.0±0.7)分,三组比较差异均无显著性(P均>0.05).结论 14岁以下轻度儿童哮喘吸入200 μg/d的BDP即能有效降低BHR,且无明显全身性副作用.而当剂量达400 μg/d时,血皮质醇对ACTH刺激的反应性明显降低,有必要作进一步的研究.     

High-dose inhaled corticosteroids and add-on therapy use in adults with asthma in the UK in 2003: an observational study.

AIMS: To quantify use of high dose inhaled corticosteroids (ICS) and add-on therapy in adults, and children aged 12 and over, in the community. METHODS: Cross-sectional observational survey of UK general practice prescribing records from July 2002 to June 2003 utilising the Doctors Independent Network clinical database. RESULTS: 30,895 patients aged 12 and over were treated for asthma with inhaled corticosteroids, with a quantifiable daily dose recommendation in 22,027 cases. Twenty-seven percent (95% Confidence Intervals 26-28%) were prescribed 'high-dose' ICS (>800 mcg/day beclomethasone or equivalent). Of these, 32% (31-33%) were not currently prescribed add-on therapy (long acting B2 agonists, leukotriene antagonists, theophylines), and most of these (84%, 82-86%) had never received a prior trial of add-on therapy. CONCLUSIONS: High dose ICS therapy was commonly prescribed to people with asthma, frequently without co-prescribed add-on therapy. Many adults with more severe asthma may be receiving treatment that does not accord with current evidence of best practice.     

Smoking affects response to inhaled corticosteroids or leukotriene receptor antagonists in asthma

RATIONALE: One-quarter to one-third of individuals with asthma smoke, which may affect response to therapy and contribute to poor asthma control. OBJECTIVES: To determine if the response to an inhaled corticosteroid or a leukotriene receptor antagonist is attenuated in individuals with asthma who smoke. METHODS: In a multicenter, placebo-controlled, double-blind, double-dummy, crossover trial, 44 nonsmokers and 39 light smokers with mild asthma were assigned randomly to treatment twice daily with inhaled beclomethasone and once daily with oral montelukast. MEASUREMENTS AND MAIN RESULTS: Primary outcome was change in prebronchodilator FEV(1) in smokers versus nonsmokers. Secondary outcomes included peak flow, PC(20) methacholine, symptoms, quality of life, and markers of airway inflammation. Despite similar FEV(1), bronchodilator response, and sensitivity to methacholine at baseline, subjects with asthma who smoked had significantly more symptoms, worse quality of life, and lower daily peak flow than nonsmokers. Adherence to therapy did not differ significantly between smokers and nonsmokers, or between treatment arms. Beclomethasone significantly reduced sputum eosinophils and eosinophil cationic protein (ECP) in both smokers and nonsmokers, but increased FEV(1) (170 ml, p = 0.0003) only in nonsmokers. Montelukast significantly increased a.m. peak flow in smokers (12.6 L/min, p = 0.002), but not in nonsmokers. CONCLUSIONS: In subjects with mild asthma who smoke, the response to inhaled corticosteroids is attenuated, suggesting that adjustments to standard therapy may be required to attain asthma control. The greater improvement seen in some outcomes in smokers treated with montelukast suggests that leukotrienes may be important in this setting. Larger prospective studies are required to determine whether leukotriene modifiers can be recommended for managing asthma in patients who smoke.     

Efficacy and safety of low-dose fluticasone propionate compared with zafirlukast in patients with persistent asthma

To compare the efficacy and safety of fluticasone propionate and zafirlukast in patients with relatively stable persistent asthma who were previously treated with inhaled corticosteroids and short-acting beta(2)-agonists.A total of 440 patients (> or =12 years of age) previously treated with inhaled corticosteroids (beclomethasone dipropionate or triamcinolone acetonide) and short-acting beta(2)-agonists were included in this randomized double-blind study. After an 8-day run-in period, patients were treated with fluticasone (88 microg) or zafirlukast (20 mg) twice daily for 6 weeks. Outcome measures included pulmonary function (forced expiratory volume in 1 second [FEV(1)], peak expiratory flow [peak flow]), albuterol use, asthma symptoms, withdrawals due to lack of efficacy, and asthma exacerbations.Patients treated with fluticasone (n = 224) experienced greater mean increases in FEV(1) (0.24 L vs. 0.08 L, P <0.001), morning peak flow (30 L/min vs. 6 L/min, P <0.001), and evening peak flow (23 L/min vs. 5 L/min, P <0.001) during the study than did those treated with zafirlukast (n = 216). Fluticasone-treated patients had significantly greater increases in the mean percentages of symptom-free days (22% vs. 8%, P <0.001), rescue-free days (23% vs. 10%, P = 0.002), nights with uninterrupted sleep (<1% vs. -5%, P = 0.006), and fewer asthma exacerbations (1% vs. 6%, P = 0.005). Fewer fluticasone-treated patients were withdrawn due to lack of efficacy (2% vs. 13%, P <0.001).Inhaled fluticasone was more effective than zafirlukast in maintaining or improving asthma control in patients with relatively stable asthma who were switched from low-dose inhaled corticosteroids.