一项针对急性哮喘加重发作后从急诊科出院的患者，比较高剂量吸入布地奈德与口服泼尼松的随机对照试验。

A randomized, controlled trial of high dose, inhaled budesonide versus oral prednisone in patients discharged from the emergency department following an acute asthma exacerbation.

作者信息

FitzGerald J M, Shragge D, Haddon J, Jennings B, Lee J, Bai T, Pare P, Kassen D, Grunfeld A

机构信息

Vancouver Hospital and Health Sciences Centre, Vancouver, Canada.

出版信息

Can Respir J. 2000 Jan-Feb;7(1):61-7. doi: 10.1155/2000/587957.

DOI:10.1155/2000/587957

PMID:10700672

Abstract

OBJECTIVE

Prednisone (PRED) is recommended at discharge to reduce the relapse rate following emergency treatment for an asthmatic attack. However, PRED has systemic side effects. Inhaled anti-inflammatory medications, such as budesonide (BUD), are well tolerated. This study was designed to compare the effectiveness of PRED and BUD on relapse rate.

DESIGN

A prospective, randomized, double-blind, double dummy, parallel group design.

SETTING

Tertiary referral emergency departments.

POPULATION STUDIED

One hundred and eighty-five patients with acute asthma who received standard treatment with bronchodilators and systemic glucocorticosteroids in the emergency department, had a forced expiration volume in 1 s (FEV1) greater than 50% predicted and who were deemed well enough to be discharged from the emergency department.

INTERVENTION

Patients were randomized to receive either BUD Turbuhaler 600 microg qid or PRED 40 mg in the morning for seven to 10 days. At discharge and final visit, symptoms, medication use, FEV1, peak expiratory flow (PEF) and quality of life (QoL) were assessed. Relapse rate to the emergency department during the follow-up was determined by a yes and/or no questionnaire.

MAIN RESULTS

The PRED (n=85) and BUD (n=90) treatment groups were comparable at baseline (emergency department discharge) for age (mean +/- SD; 27.6+/-8.5 years and 29. 2+/-8.7 years) and prebronchodilator FEV1 (1.77+/-0.79 L and 1. 75+/-0.78 L), respectively. BUD was at least as effective as PRED in preventing a relapse to the hospital; relapse rate was 10 (11.8%) during PRED treatment and nine (10.0%) for BUD treatment (95% CI PRED-BUD, -7.5% to 11.0%). Improvements in FEV1, asthma symptoms, PEF and QoL were not significantly different between treatments.

CONCLUSIONS

In patients whose acute asthma has been stabilized in the emergency department, high dose BUD may be an alternate to PRED as a follow-up treatment.

摘要

目的

推荐在哮喘发作急诊治疗出院时使用泼尼松（PRED）以降低复发率。然而，PRED有全身副作用。吸入性抗炎药物，如布地奈德（BUD），耐受性良好。本研究旨在比较PRED和BUD对复发率的有效性。

设计

前瞻性、随机、双盲、双模拟、平行组设计。

地点

三级转诊急诊科。

研究对象

185例急性哮喘患者，这些患者在急诊科接受了支气管扩张剂和全身糖皮质激素的标准治疗，1秒用力呼气量（FEV1）大于预测值的50%，且被认为身体状况良好足以从急诊科出院。

干预措施

患者被随机分为接受布地奈德都保600微克每日4次或早晨服用PRED 40毫克，持续7至10天。在出院时和最后一次随访时，评估症状、药物使用情况、FEV1、呼气峰值流速（PEF）和生活质量（QoL）。通过是或否的问卷确定随访期间到急诊科的复发率。

主要结果

PRED组（n = 85）和BUD组（n = 90）在基线（急诊科出院时）的年龄（均值±标准差；分别为27.6±8.5岁和29.2±8.7岁）和支气管扩张剂前FEV1（1.77±0.79升和1.75±0.78升）方面具有可比性。BUD在预防复发至医院方面至少与PRED一样有效；PRED治疗期间复发率为10例（11.8%），BUD治疗期间为9例（10.0%）（95%可信区间PRED - BUD，-7.5%至11.0%）。治疗之间FEV1、哮喘症状、PEF和QoL的改善无显著差异。