Niitsuma Tomoyuki, Okita Misa, Sakurai Kahori, Morita Sonoko, Tsuyuguchi Miyako, Matsumura Yasuhiro, Hayashi Tohru, Koshishi Tohru, Oka Kitaro, Homma Masato
Third Department of Internal Medicine, Tokyo Medical University, Shinjyuku-ku, Tokyo, Japan.
J Asthma. 2003;40(5):515-22. doi: 10.1081/jas-120018781.
Low-dose adrenocorticotropin hormone (ACTH) tests (0.5 microg/L 73 m2) were done before and after switching from inhaled beclomethasone dipropionate to inhaled fluticasone propionate in 12 patients 33-77 years old who had mild-to-severe asthma to compare the effects of these drugs on adrenal function. Low-dose ACTH tests were performed after the subjects had received inhaled beclomethasone dipropionate (200-900 microg/day) for at least 12 wk. Treatment was then switched to inhaled fluticasone propionate (200-600 microg/day) for at least 12 wk, and a second low-dose ACTH test was done. Pulmonary function was assessed on the basis of peak expiratory flow rate (PEFR, % of predicted value). After switching treatment, the daily dose of inhaled corticosteroid decreased by about 40%. Basal serum cortisol and ACTH levels were similar with both treatments. The adrenal response, as assessed by incremental rise in the serum cortisol level (peak minus basal) after ACTH challenge, improved significantly (5.6-7.9 microg/dL, p < 0.01) after switching to fluticasone. All three patients who had lower serum cortisol levels during beclomethasone treatment than during fluticasone treatment showed improvement in both the peak cortisol level and the incremental rise in cortisol. Mean morning and evening PEFRs significantly increased after switching from beclomethasone to fluticasone (morning: 71.2 to 76.0%, p < 0.01; evening: 67.3 to 72.1%, both p < 0.05). The diurnal variation of PEFR significantly decreased from 10.9% to 8.3% after switching treatment (p < 0.01). We conclude that switching from beclomethasone to fluticasone reduces the risk of adrenal dysfunction associated with inhaled steroids and improves pulmonary function.
对12例年龄在33至77岁、患有轻至重度哮喘的患者，在从吸入丙酸倍氯米松转换为吸入丙酸氟替卡松之前和之后进行了低剂量促肾上腺皮质激素（ACTH）试验（0.5微克/升·73平方米），以比较这些药物对肾上腺功能的影响。在受试者接受吸入丙酸倍氯米松（200 - 900微克/天）至少12周后进行低剂量ACTH试验。然后将治疗转换为吸入丙酸氟替卡松（200 - 600微克/天）至少12周，并进行第二次低剂量ACTH试验。根据呼气峰值流速（PEFR，预测值的百分比）评估肺功能。转换治疗后，吸入性糖皮质激素的每日剂量降低了约40%。两种治疗的基础血清皮质醇和ACTH水平相似。通过ACTH激发后血清皮质醇水平的增量升高（峰值减去基础值）评估的肾上腺反应，在转换为氟替卡松后显著改善（5.6 - 7.9微克/分升，p < （此处原文有误，推测应为p < 0.01））。在丙酸倍氯米松治疗期间血清皮质醇水平低于丙酸氟替卡松治疗期间的所有3例患者，其皮质醇峰值水平和皮质醇增量升高均有所改善。从丙酸倍氯米松转换为丙酸氟替卡松后，平均早晨和晚上的PEFR显著增加（早晨：71.2%至76.0%，p < 0.01；晚上：67.3%至72.1%，两者p < 0.05）。转换治疗后，PEFR的昼夜变化从10.9%显著降低至8.3%（p < 0.01）。我们得出结论，从丙酸倍氯米松转换为丙酸氟替卡松可降低与吸入性类固醇相关的肾上腺功能障碍风险并改善肺功能。
