Douma W Rob, Kerstjens Huib A M, de Gooijer Ad, Overbeek Shelley E, Koëter Gerard H, Postma Dirkje S
Department of Pulmonology, University Hospital Groningen, Groningen, The Netherlands.
Chest. 2002 Jan;121(1):151-7. doi: 10.1378/chest.121.1.151.
Treatment with inhaled corticosteroids reduces bronchial hyperresponsiveness and relieves airways obstruction in patients with asthma. Up to now, it is unknown whether initial improvements are maintained over a long period of time. Therefore, we assessed whether initial improvements in FEV(1), provocative concentration of histamine causing a 20% fall in FEV(1) (PC(20)), and peak expiratory flow (PEF) persist with a constant dose of inhaled corticosteroids. Furthermore, we investigated whether FEV(1), PC(20), PEF indexes, and symptom scores improve after increasing the dose of inhaled corticosteroids in patients who did not respond sufficiently to treatment with beclomethasone dipropionate (BDP), 800 microg/d.
Sixty-eight patients with bronchial hyperresponsiveness and airways obstruction completed a previous study on 3 years of treatment with terbutaline, 500 microg qid, and BDP, 200 microg qid. Fifty-eight of these patients participated in the current extension of another 2.5 years of follow-up. Every 6 months, FEV(1) and PC(20) were measured. Five patients dropped out of the study, one for pulmonary reasons. Forty-four patients continued treatment with BDP, 800 microg/d (BDP-800 group), and 9 patients received a higher dose of BDP (500 microg tid; BDP-1,500 group) after the first 3 years because of a rapid decline in FEV(1) (> 50 mL/yr) despite BDP treatment during the previous study period.
After the initial improvement, the mean slope of individual regression lines for FEV(1), PC(20), and morning PEF were - 28 mL/yr, - 0.01 doubling concentrations per year, and 0.6 L/min/yr, respectively, in the BDP-800 group. In the BDP-1,500 group, there were no statistically significant improvements in FEV(1), PC(20), PEF indexes, and symptom scores after increasing the dose of BDP.
We conclude that initial improvements in FEV(1), PC(20), and PEF are well preserved over 5 years in patients with obstructive airways diseases who are treated with terbutaline and BDP. In the patients who responded sufficiently to 800 microg/d of BDP, there was no accelerated decline in FEV(1) compared with the general population. Increasing the dose of BDP in a small group of patients with an accelerated fall in FEV(1) (initially treated with a moderate dose of BDP) resulted in no significant improvement in FEV(1), PC(20), PEF indexes, and symptom scores.
吸入性糖皮质激素治疗可降低哮喘患者的支气管高反应性并缓解气道阻塞。迄今为止，尚不清楚初始改善是否能长期维持。因此，我们评估了在持续吸入固定剂量糖皮质激素的情况下，第一秒用力呼气容积（FEV₁）、使FEV₁下降20%的组胺激发浓度（PC₂₀）和呼气峰值流速（PEF）的初始改善情况是否能持续。此外，我们还研究了对于丙酸倍氯米松（BDP）800μg/天治疗反应欠佳的患者，增加吸入性糖皮质激素剂量后，FEV₁、PC₂₀、PEF指标及症状评分是否有所改善。
68例支气管高反应性和气道阻塞患者完成了一项为期3年的关于特布他林500μg每日4次和BDP 200μg每日4次治疗的研究。其中58例患者参与了本次为期2.5年的随访研究。每6个月测量一次FEV₁和PC₂₀。5例患者退出研究，1例因肺部原因退出。在前3年中，尽管接受了BDP治疗，但仍有44例患者FEV₁快速下降（>50 mL/年），这些患者继续接受BDP 800μg/天治疗（BDP - 800组）；9例患者在最初3年后因FEV₁快速下降而接受更高剂量的BDP（500μg每日3次；BDP - 1500组）。
在BDP - 800组中，初始改善后，FEV₁、PC₂₀和清晨PEF的个体回归线平均斜率分别为每年 - 28 mL、每年 - 0.01倍浓度增加和每年0.6 L/分钟。在BDP - 1500组中，增加BDP剂量后，FEV₁、PC₂₀、PEF指标及症状评分无统计学意义上的改善。
我们得出结论，在接受特布他林和BDP治疗的阻塞性气道疾病患者中，FEV₁、PC₂₀和PEF的初始改善在5年内得到了很好的维持。在对800μg/天BDP反应充分的患者中，与普通人群相比，FEV₁没有加速下降。在一小部分FEV₁下降加速（最初接受中等剂量BDP治疗）的患者中增加BDP剂量后，FEV₁、PC₂₀、PEF指标及症状评分没有显著改善。
