Sears M R, Taylor D R, Print C G, Lake D C, Herbison G P, Flannery E M
Department of Medicine, University of Otago Medical School, Dunedin, New Zealand.
Chest. 1992 Dec;102(6):1709-15. doi: 10.1378/chest.102.6.1709.
Undertreatment of chronic asthma may reflect uncertainty as to how it may be best controlled. We compared the effects of increased inhaled corticosteroid vs regular inhaled bronchodilator in 32 adult asthmatics. During three 16-week treatment periods, comprising baseline inhaled corticosteroid (mean 505 micrograms daily) and on-demand beta-agonist, baseline inhaled corticosteroid and increased (regularly scheduled four times daily) beta-agonist, and increased inhaled corticosteroid (mean 1478 micrograms daily) and on-demand beta-agonist, subjects recorded symptoms, morning and evening peak flow, and additional medication. Of 25 subjects whose control differed significantly between treatments with baseline vs increased corticosteroid, 22 (88 percent) favored the increased dosage (p < 0.001). Of 28 subjects whose control differed between treatments with regular beta-agonist vs increased corticosteroid, 24 (86 percent) were better controlled with increased inhaled corticosteroid and were worse with regular beta-agonist (p < 0.001). Only one quarter the number of exacerbations were experienced during treatment with increased inhaled corticosteroid. Upper airway adverse effects were minor and easily controlled. Hence, asthma with persistent symptoms was better controlled by increased inhaled corticosteroid therapy than by increased use of inhaled beta-agonist.
慢性哮喘治疗不足可能反映出在如何实现最佳控制方面存在不确定性。我们比较了增加吸入性糖皮质激素与常规吸入性支气管扩张剂对32名成年哮喘患者的影响。在三个为期16周的治疗阶段中，包括基线吸入性糖皮质激素（平均每日505微克）和按需使用的β受体激动剂、基线吸入性糖皮质激素和增加剂量（每日定时四次）的β受体激动剂，以及增加剂量的吸入性糖皮质激素（平均每日1478微克）和按需使用的β受体激动剂，受试者记录症状、早晚峰流速以及额外用药情况。在25名在基线糖皮质激素治疗与增加剂量糖皮质激素治疗之间控制情况有显著差异的受试者中，22名（88%）倾向于增加剂量（p<0.001）。在28名在常规β受体激动剂治疗与增加剂量糖皮质激素治疗之间控制情况有差异的受试者中，24名（86%）在增加吸入性糖皮质激素治疗时控制更好，而在常规β受体激动剂治疗时控制更差（p<0.001）。在增加吸入性糖皮质激素治疗期间，发作次数仅为原来的四分之一。上呼吸道不良反应轻微且易于控制。因此，对于有持续症状的哮喘，增加吸入性糖皮质激素治疗比增加吸入性β受体激动剂的使用能更好地控制病情。
