Goldberg Shmuel, Einot Tsurit, Algur Nurit, Schwartz Shimshon, Greenberg Alan C, Picard Elie, Virgilis Dov, Kerem Eitan
Department of Pediatric Respiratory Medicine, Shaare Zedek Medical Center, Hebrew University Medical School, Jerusalem, Israel.
Ann Allergy Asthma Immunol. 2002 Dec;89(6):566-71. doi: 10.1016/S1081-1206(10)62103-5.
Dry powder inhalers (DPI) have in recent years become a common mode for administration of inhaled corticosteroids for preventive therapy of asthma. Inhaled steroids delivered by DPI achieve increased lung deposition compared with pressurized metered-dose inhalers (pMDI), which is associated with increased therapeutic effect. This may be associated with increased systemic absorption.
The purpose of this study was to evaluate the prevalence of adrenal suppression in children using low-dose budesonide given by DPI, as compared with pMDI attached to a large-volume spacer device (pMDI + spacer).
In an open-labeled crossover study, 15 asthmatic children aged 5 to 15 years received 200 microg of inhaled budesonide twice daily by DPI (Turbuhaler, Astra, Draco AB, Lund, Sweden) and by pMDI + spacer, 1 month each, in a randomized order. Twenty-four-hour urine collections were performed at baseline and at the end of each of the 2 months of the study period, and urinary cortisol and creatinine were measured.
Baseline urinary cortisol:creatinine was 0.038 +/- 0.012 microg/mg, similar in both groups. After 1 month of DPI therapy, urinary cortisol:creatinine was reduced by 27 +/- 16% to 0.028 +/- 0.012 microg/mg (P = 0.018). Urinary cortisol:creatinine after 1 month of pMDI + spacer therapy was similar to baseline 0.037 +/- 0.019 microg/mg (P = 0.78).
Treatment of asthmatic children with budesonide 400 microg daily given via a DPI for 1 month was associated with hypothalamic-pituitary-adrenal axis suppression. This effect was not observed with the same dose of budesonide administered via pMDI + spacer. This indicates that systemic absorption might be reduced with pMDI + spacer therapy.
近年来，干粉吸入器（DPI）已成为吸入性糖皮质激素用于哮喘预防性治疗的常用给药方式。与压力定量吸入器（pMDI）相比，DPI递送的吸入性类固醇在肺部的沉积增加，这与治疗效果增强相关。这可能与全身吸收增加有关。
本研究的目的是评估与使用大容量储雾罐装置的pMDI（pMDI + 储雾罐）相比，使用DPI给予低剂量布地奈德的儿童中肾上腺抑制的发生率。
在一项开放标签的交叉研究中，15名5至15岁的哮喘儿童以随机顺序，分别通过DPI（都保，阿斯特拉，德科AB公司，瑞典隆德）和pMDI + 储雾罐，每日两次吸入200微克布地奈德，每次1个月。在研究期的2个月的基线期和每个月结束时收集24小时尿液，并测量尿皮质醇和肌酐。
基线尿皮质醇：肌酐为0.038±0.012微克/毫克，两组相似。DPI治疗1个月后，尿皮质醇：肌酐降低27±16%至0.028±0.012微克/毫克（P = 0.018）。pMDI + 储雾罐治疗1个月后的尿皮质醇：肌酐与基线0.037±0.019微克/毫克相似（P = 0.78）。
通过DPI每日给予400微克布地奈德治疗哮喘儿童1个月与下丘脑 - 垂体 - 肾上腺轴抑制有关。通过pMDI + 储雾罐给予相同剂量的布地奈德未观察到这种效应。这表明pMDI + 储雾罐治疗可能会减少全身吸收。
