Orsida B E, Ward C, Li X, Bish R, Wilson J W, Thien F, Walters E H
Department of Respiratory Medicine, The Alfred Hospital and Monash University Medical School, Melbourne, Victoria, Australia.
Am J Respir Crit Care Med. 2001 Jul 1;164(1):117-21. doi: 10.1164/ajrccm.164.1.2006003.
There are few data regarding the potential effects of antiasthma treatment on indices of airway remodeling, such as the increased subepithelial airway vascularity in patients with asthma. We studied 45 symptomatic subjects with asthma who were receiving treatment with low dose inhaled corticosteroids (ICS) (range 200-500 microg twice a day) and 28 normal subjects without asthma as a control population. Subjects underwent bronchoscopy with airway biopsy and subjects with asthma were then randomized to receive supplementary inhaled salmeterol 50 microg twice a day, fluticasone propionate 100 microg twice a day, or placebo for 3 mo in addition to their baseline ICS. Biopsy of the airway was then repeated. The biopsies were analyzed for vascular structures in the subepithelial lamina propria. Sufficient biopsy material was available for analysis of vascularity in 34 of the subjects with asthma and 28 of the normal subjects. We confirmed that airways of subjects with asthma had a significant increase in the number of vessels/mm2 of lamina propria compared with airways of normal subjects (524 +/- 137 vessels/mm2, n = 34 versus 425 +/- 130 vessels/mm2, n = 28; p = 0.004). There was a decrease in the density of vessels of lamina propria after treatment only in the salmeterol group compared with baseline (before, 535 +/- 153 vessels/mm2 versus after, 400 +/- 142 vessels/mm2; n = 12; p = 0.04). There was no significant change within the fluticasone (n = 11) or placebo (n = 11) treatment groups, but also no significant differences between the groups. Notably, no treatment was associated with increased airway wall vascularity. The demonstrated fall in vessel number within the salmeterol-treated group may suggest an advantageous effect of long-acting beta2-agonists on this manifestation of airway remodeling over the 3-mo time scale of this study, which is complementary to the action of ICS on airway vascularity.
关于抗哮喘治疗对气道重塑指标的潜在影响的数据很少，比如哮喘患者气道上皮下血管增多。我们研究了45名有症状的哮喘患者，他们正在接受低剂量吸入性糖皮质激素（ICS）治疗（范围为每日两次，每次200 - 500微克），并将28名无哮喘的正常受试者作为对照人群。受试者接受了支气管镜检查及气道活检，然后将哮喘患者随机分为三组，分别额外接受每日两次、每次50微克的沙美特罗吸入治疗，每日两次、每次100微克的丙酸氟替卡松吸入治疗，或安慰剂治疗，为期3个月，同时继续他们的基线ICS治疗。之后再次进行气道活检。对活检组织进行上皮下固有层血管结构分析。有足够的活检材料可用于分析34名哮喘受试者和28名正常受试者的血管情况。我们证实，与正常受试者的气道相比，哮喘受试者气道固有层每平方毫米血管数量显著增加（524 ± 137条血管/平方毫米，n = 34，对比425 ± 130条血管/平方毫米，n = 28；p = 0.004）。与基线相比，仅沙美特罗治疗组治疗后固有层血管密度降低（治疗前，535 ± 153条血管/平方毫米；治疗后，400 ± 142条血管/平方毫米；n = 12；p = 0.04）。丙酸氟替卡松治疗组（n = 11）和安慰剂治疗组（n = 11）内均无显著变化，且两组之间也无显著差异。值得注意的是，没有任何一种治疗会导致气道壁血管增多。沙美特罗治疗组血管数量的下降表明，在本研究的3个月时间尺度上，长效β2受体激动剂对气道重塑的这一表现可能具有有利作用，这与ICS对气道血管的作用相辅相成。
