Loppow D, Schleiss M B, Kanniess F, Taube C, Jörres R A, Magnussen H
Krankenhaus Grosshansdorf, Zentrum für Pneumologie und Thoraxchirurgie, Germany.
Respir Med. 2001 Feb;95(2):115-21. doi: 10.1053/rmed.2000.0960.
Systemic corticosteroids have been recommended as a therapeutic option in patients with moderate to severe COPD. In an early stage of the disease, i.e. chronic bronchitis with mild or no airflow obstruction, a trial with inhaled steroids could reveal potential benefits, particularly in terms of a modulation of airway inflammation. We therefore investigated the effect of inhaled fluticasone (1000 microg day(-1)) on markers of airway inflammation in 19 patients with chronic bronchitis (mean+/-SEM FEV1, 83.4+/-3.0% predicted; FEV1/VC, 67.5+/-2.4%) in a double-blind, cross-over, placebo-controlled manner. Visits were performed before and after two 4-week treatment periods. separated by a 4-week washout period. Lung function, the concentration of exhaled nitric oxide, differential cell counts in induced sputum and the number of cells positive for iNOS, as well as the levels of LDH, ECP, neutrophil elastase and IL-8 in sputum supernatants were determined. Although the total cell number decreased significantly after fluticasone (geometric mean 12.3 vs. 7.7 x 10(6)/ml; P<0.05) it was not significantly different from the change observed after placebo (14.2 vs. 10.6 x 10(6)/ml; n.s.). None of the other parameters showed statistically significant changes after fluticasone or placebo and the results did not depend on the presence of airway hyperresponsiveness. We conclude that in patients with chronic bronchitis short-term treatment with inhaled corticosterids did not improve lung function or inflammatory parameters to an extent which was statistically significant as compared to spontaneous variability.
全身用皮质类固醇已被推荐作为中重度慢性阻塞性肺疾病（COPD）患者的一种治疗选择。在疾病的早期阶段，即伴有轻度气流受限或无气流受限的慢性支气管炎阶段，吸入性类固醇试验可能会显示出潜在益处，尤其是在调节气道炎症方面。因此，我们采用双盲、交叉、安慰剂对照的方式，研究了吸入氟替卡松（1000微克/天）对19例慢性支气管炎患者（平均±标准误FEV1为预测值的83.4±3.0%；FEV1/VC为67.5±2.4%）气道炎症标志物的影响。在两个为期4周的治疗期之前和之后进行访视，两个治疗期之间间隔4周的洗脱期。测定肺功能、呼出一氧化氮浓度、诱导痰中的细胞分类计数和诱导型一氧化氮合酶（iNOS）阳性细胞数量，以及痰上清液中乳酸脱氢酶（LDH）、嗜酸性粒细胞阳离子蛋白（ECP）、中性粒细胞弹性蛋白酶和白细胞介素-8（IL-8）的水平。尽管氟替卡松治疗后总细胞数显著减少（几何平均数12.3对7.7×10⁶/ml；P<0.05），但与安慰剂治疗后的变化无显著差异（14.2对10.6×10⁶/ml；无统计学意义）。氟替卡松或安慰剂治疗后，其他参数均未显示出统计学上的显著变化，且结果不依赖于气道高反应性的存在。我们得出结论，对于慢性支气管炎患者，与自发变异性相比，吸入性皮质类固醇短期治疗在改善肺功能或炎症参数方面未达到具有统计学意义的程度。
