Gross G, Thompson P J, Chervinsky P, Vanden Burgt J
Dallas Allergy and Asthma Center, TX, USA.
Chest. 1999 Feb;115(2):343-51. doi: 10.1378/chest.115.2.343.
The improved lung deposition of hydrofluoroalkane-134a beclomethasone dipropionate (HFA-BDP) extrafine aerosol compared with chlorofluorocarbon beclomethasone dipropionate (CFC-BDP) suggests that lower doses of HFA-BDP may be required to provide equivalent asthma control. The present study was undertaken to test this hypothesis.
A 10- to 12-day run-in period confirmed that patients met established criteria of at least moderate asthma and the asthma was inadequately controlled by current therapy (inhaled beta-agonist and CFC-BDP [< or = 400 microg/d]). A short course of oral prednisone, 30 mg/d for 7 to 12 days, was followed to establish the patients were steroid responsive and to provide an "in-study" baseline of "optimal" asthma control.
A total of 347 patients were then randomized to HFA-BDP 400 microg/d, CFC-BDP 800 microg/d, or HFA-placebo for 12 weeks.
Morning peak expiratory flow (AM PEF) measurements showed that HFA-BDP 400 microg/d achieved equivalent control of asthma to CFC-BDP 800 microg/d at all time intervals after oral steroid treatment. All other efficacy variables supported the AM PEF results and both active treatments were more effective than placebo. The safety profile of HFA-BDP compared favorably with that of CFC-BDP with no unexpected adverse events reported.
These findings demonstrate that HFA-BDP provides equivalent control of moderate or moderately severe asthma as CFC-BDP in the population studied, but at half the total daily dose.
与氯氟碳丙酸倍氯米松(CFC-BDP)相比,氢氟烷-134a丙酸倍氯米松(HFA-BDP)超细气雾剂在肺部的沉积有所改善,这表明可能需要较低剂量的HFA-BDP来提供等效的哮喘控制。本研究旨在验证这一假设。
为期10至12天的导入期证实患者符合至少中度哮喘的既定标准,且当前治疗(吸入β-激动剂和CFC-BDP[≤400μg/d])无法充分控制哮喘。随后给予患者短期口服泼尼松,30mg/d,持续7至12天,以确定患者对类固醇有反应,并提供“研究中”“最佳”哮喘控制的基线。
然后,共有347名患者被随机分为接受12周的HFA-BDP 400μg/d、CFC-BDP 800μg/d或HFA-安慰剂治疗。
早晨呼气峰流速(AM PEF)测量显示,口服类固醇治疗后的所有时间间隔内,HFA-BDP 400μg/d实现了与CFC-BDP 800μg/d等效的哮喘控制。所有其他疗效变量均支持AM PEF结果,两种活性治疗均比安慰剂更有效。HFA-BDP的安全性优于CFC-BDP,未报告意外不良事件。
这些发现表明,在所研究的人群中,HFA-BDP与CFC-BDP一样能有效控制中度或中度重度哮喘,但每日总剂量仅为其一半。