Verhoeven G T, Hegmans J P J J, Mulder P G H, Bogaard J M, Hoogsteden H C, Prins J-B
Department of Pulmonary and Intensive Care Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
Thorax. 2002 Aug;57(8):694-700. doi: 10.1136/thorax.57.8.694.
Treatment of chronic obstructive pulmonary disease (COPD) with inhaled corticosteroids does not appear to be as effective as similar treatment of asthma. It seems that only certain subgroups of patients with COPD benefit from steroid treatment. A study was undertaken to examine whether inhaled fluticasone propionate (FP) had an effect on lung function and on indices of inflammation in a subgroup of COPD patients with bronchial hyperresponsiveness (BHR).
Twenty three patients with COPD were studied. Patients had to be persistent current smokers between 40 and 70 years of age. Non-specific BHR was defined as a PC(20) for histamine of <or=8 mg/ml. Patients received either 2 x 500 microg FP or placebo for 6 months. Expiratory volumes were measured at monthly visits, BHR was determined at the start of the study and after 3 and 6 months, and bronchial biopsy specimens were taken at the start and after 6 months of treatment. Biopsy specimens from asymptomatic smokers served as controls.
In contrast to asthma, indices of BHR were not significantly influenced by treatment with FP. Forced expiratory volume in 1 second (FEV(1)) showed a steep decline in the placebo group but remained stable in patients treated with FP. FEV(1)/FVC, and maximal expiratory flows at 50% and 25% FVC (MEF(50), MEF(25)) were significantly increased in the FP treated patients compared with the placebo group. Biopsy specimens were analysed for the presence of CD3+, CD4+, CD8+, MBP+, CD15+, CD68+, CD1a, and tryptase cells. FP treatment resulted in marginal reductions in these indices of inflammation.
In patients with COPD and BHR, FP has a positive effect on indices of lung function compared with placebo. Bronchial inflammation analysed in bronchial biopsy specimens is only marginally reduced.
吸入性糖皮质激素治疗慢性阻塞性肺疾病（COPD）似乎不如治疗哮喘那样有效。似乎只有某些COPD患者亚组能从激素治疗中获益。开展了一项研究，以检查吸入丙酸氟替卡松（FP）对具有支气管高反应性（BHR）的COPD患者亚组的肺功能和炎症指标是否有影响。
研究了23例COPD患者。患者必须为年龄在40至70岁之间的持续吸烟者。非特异性BHR定义为组胺激发试验的PC（20）≤8mg/ml。患者接受2×500μg FP或安慰剂治疗6个月。每月就诊时测量呼气容积，在研究开始时、3个月和6个月后测定BHR，并在治疗开始时和6个月后采集支气管活检标本。无症状吸烟者的活检标本用作对照。
与哮喘不同，BHR指标不受FP治疗的显著影响。安慰剂组的1秒用力呼气容积（FEV（1））急剧下降，而接受FP治疗的患者中FEV（1）保持稳定。与安慰剂组相比，接受FP治疗的患者的FEV（1）/FVC以及FVC为50%和25%时的最大呼气流量（MEF（50），MEF（25））显著增加。对活检标本分析CD3 +、CD4 +、CD8 +、MBP +、CD15 +、CD68 +、CD1a和类胰蛋白酶细胞的存在情况。FP治疗使这些炎症指标略有降低。
在患有COPD和BHR患者中，与安慰剂相比，FP对肺功能指标有积极影响。支气管活检标本中分析的支气管炎症仅略有减轻。
