Tattersfield A E, Postma D S, Barnes P J, Svensson K, Bauer C A, O'Byrne P M, Löfdahl C G, Pauwels R A, Ullman A
Division of Respiratory Medicine, Nottingham University, Nottingham, and National Heart and Lung Institute, Imperial College, London, United Kingdom.
Am J Respir Crit Care Med. 1999 Aug;160(2):594-9. doi: 10.1164/ajrccm.160.2.9811100.
The identification, prevention, and prompt treatment of exacerbations are major objectives of asthma management. We looked at change in PEF, symptoms, and use of rescue beta-agonists during the 425 severe exacerbations that occurred during a 12-mo parallel group study (FACET) in which low and high doses of budesonide with and without formoterol were compared in patients with asthma. Oral corticosteroids were prescribed for severe exacerbations, the main study end point, defined as the need for a course of oral corticosteroids (n = 311) or a reduction in morning PEF of > 30% on two consecutive days. PEF, symptoms, and bronchodilator use over the 14 d before and after the exacerbation were obtained from diary cards. Exacerbations were characterized by a gradual fall in PEF over several days, followed by more rapid changes over 2 to 3 d; an increase in symptoms and rescue beta-agonist use occurred in parallel, and both the severity and time course of the changes were similar in all treatment groups. Exacerbations identified by the need for oral corticosteroids were associated with more symptoms and smaller changes in PEF than those identified on the basis of PEF criteria. Female sex was the main patient characteristic associated with an increased risk of having a severe exacerbation. Exacerbations may be characterized predominantly by change in symptoms or change in PEF, but the pattern was not affected by the dose of inhaled corticosteroid or by whether the patient was taking formoterol.
哮喘加重的识别、预防及及时治疗是哮喘管理的主要目标。在一项为期12个月的平行组研究（FACET）中，我们观察了425次严重加重发作期间的呼气峰流速（PEF）变化、症状以及急救β-受体激动剂的使用情况。该研究比较了哮喘患者使用低剂量和高剂量布地奈德加或不加福莫特罗的效果。对于严重加重发作（主要研究终点），即需要接受一个疗程的口服糖皮质激素治疗（n = 311）或连续两天早晨PEF下降超过30%的情况，给予口服糖皮质激素治疗。加重发作前后14天的PEF、症状及支气管扩张剂使用情况通过日记卡获取。加重发作的特点是PEF在数天内逐渐下降，随后在2至3天内变化更快；症状及急救β-受体激动剂的使用同时增加，且所有治疗组中这些变化的严重程度和时间进程相似。因需要口服糖皮质激素而确定的加重发作比基于PEF标准确定的加重发作伴有更多症状且PEF变化更小。女性是与严重加重发作风险增加相关的主要患者特征。加重发作可能主要表现为症状变化或PEF变化，但这种模式不受吸入性糖皮质激素剂量或患者是否使用福莫特罗的影响。
