Gibson P G, Saltos N, Fakes K
Airway Research Centre, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia.
Am J Respir Crit Care Med. 2001 Jan;163(1):32-6. doi: 10.1164/ajrccm.163.1.9807061.
Corticosteroids can have acute effects on airway function and methacholine airway responsiveness in asthma as early as 6 h after dosing, suggesting there may be an acute anti-inflammatory effect of inhaled corticosteroid in asthma. This study aimed to determine the effects of a single dose of inhaled budesonide on sputum eosinophils and mast cells in adults with asthma, and to examine whether the mechanism of clearance of eosinophils was by apoptosis. A randomized, double-blind, placebo-controlled, crossover study was conducted. At the screening visit, adults with stable asthma (n = 41) ceased inhaled corticosteroid therapy for 4 d and those with significant sputum eosinophilia (> or = 7%) were randomized (n = 26) to a single dose of budesonide 2,400 microg or placebo via Turbuhaler, on two separate study days. Symptoms and lung function were followed for 6 h, then sputum was induced and airway responsiveness to hypertonic saline determined. Sputum eosinophils (mean, SE) were significantly lower 6 h after budesonide (25%, 4.5), compared with placebo (37%, 6.2, p < 0.05). There was a 2.2-fold (95% CI 1.45 to 3.33) improvement in airway responsiveness with budesonide. No significant difference was seen on mast cells, apoptotic eosinophils, symptoms, or lung function. In conclusion, a single dose of inhaled corticosteroids has beneficial effects on airway inflammation and airway hyperresponsiveness as early as 6 h after dosing. This may be clinically useful as therapy during mild exacerbations of asthma.
皮质类固醇对哮喘患者的气道功能和乙酰甲胆碱气道反应性可产生急性影响，最早在给药后6小时即可出现，这表明吸入性皮质类固醇在哮喘中可能具有急性抗炎作用。本研究旨在确定单剂量吸入布地奈德对成年哮喘患者痰液嗜酸性粒细胞和肥大细胞的影响，并探讨嗜酸性粒细胞的清除机制是否为凋亡。进行了一项随机、双盲、安慰剂对照的交叉研究。在筛查访视时，稳定期哮喘成年患者（n = 41）停用吸入性皮质类固醇治疗4天，痰液嗜酸性粒细胞显著增多（≥7%）的患者（n = 26）在两个不同的研究日通过都保分别随机接受单剂量2400微克布地奈德或安慰剂治疗。随访症状和肺功能6小时，然后诱导痰液并测定气道对高渗盐水的反应性。与安慰剂组（37%，6.2）相比，布地奈德治疗6小时后痰液嗜酸性粒细胞（均值，标准误）显著降低（25%，4.5），差异有统计学意义（p < 0.05）。布地奈德治疗后气道反应性改善了2.2倍（95%可信区间1.45至3.33）。肥大细胞、凋亡嗜酸性粒细胞、症状或肺功能方面未见显著差异。总之,单剂量吸入皮质类固醇在给药后6小时即可对气道炎症和气道高反应性产生有益影响。这在哮喘轻度加重期的治疗中可能具有临床应用价值。
