Barnes P J
Department of Thoracic Medicine, National Heart and Lung Institute, Imperial College, London, UK.
Respir Med. 2001 Aug;95 Suppl B:S12-6. doi: 10.1053/rmed.2001.1140.
Current asthma management guidelines state that where a patient is receiving a low to moderate dose of inhaled corticosteroids and is still experiencing symptoms the dose of corticosteroid should be increased and, if necessary, a long-acting bronchodilator should be added. Many studies have now shown that the addition of a beta2-agonist with long-acting properties is more effective at controlling asthma symptoms than increasing the dose of corticosteroid alone. The Formoterol and Corticosteroid Establishing Therapy (FACET) study was a 12-month study comparing exacerbation rates in patients treated with budesonide (100 microg or 400 microg) twice daily alone vs, treatment with budesonide (100 microg or 400 microg) twice daily plus formoterol 9 microg twice daily (delivered dose). The addition of formoterol reduced the rates of mild and severe exacerbations compared with budesonide alone, with the lowest rates seen in patients receiving high-dose budesonide and formoterol. There was no difference in the profile of exacerbations in any groups, indicating formoterol does not mask any signs of inflammation. The addition of formoterol to budesonide was also shown to result in improved lung function (as measured by peak expiratory flow rate and forced expiratory volume in 1 second), night-time awakenings and the use of as-needed medication when compared with an increase in the dose of budesonide. In all cases, increasing the dose of budesonide and addition of formoterol resulted in the most improvement and a significant increase in quality of life, measured by Asthma Quality of Life Questionnaire (AQLQ), was noted. In conclusion, the addition of formoterol to established treatment with inhaled corticosteroids provides superior asthma control compared with an increase in the dose of corticosteroid alone.
当前的哮喘管理指南指出，若患者正在接受低至中等剂量的吸入性糖皮质激素治疗但仍有症状，应增加糖皮质激素的剂量，如有必要，还应添加长效支气管扩张剂。现在许多研究表明，添加具有长效特性的β2受体激动剂在控制哮喘症状方面比单独增加糖皮质激素剂量更有效。福莫特罗和糖皮质激素确立疗法（FACET）研究是一项为期12个月的研究，比较了单独每日两次使用布地奈德（100微克或400微克）治疗的患者与每日两次使用布地奈德（100微克或400微克）加福莫特罗9微克每日两次（递送剂量）治疗的患者的急性加重率。与单独使用布地奈德相比，添加福莫特罗降低了轻度和重度急性加重的发生率，在接受高剂量布地奈德和福莫特罗的患者中发生率最低。任何组的急性加重情况均无差异，表明福莫特罗不会掩盖任何炎症迹象。与增加布地奈德剂量相比，在布地奈德中添加福莫特罗还可改善肺功能（通过呼气峰值流速和1秒用力呼气量测量）、减少夜间觉醒以及减少按需使用药物的情况。在所有情况下，增加布地奈德剂量并添加福莫特罗带来的改善最大，通过哮喘生活质量问卷（AQLQ）测量，生活质量有显著提高。总之，与单独增加糖皮质激素剂量相比，在已有的吸入性糖皮质激素治疗中添加福莫特罗可提供更好的哮喘控制。
