哮喘急性发作时布地奈德双倍剂量与维持治疗的对比
Doubling the dose of budesonide versus maintenance treatment in asthma exacerbations.
作者信息
FitzGerald J M, Becker A, Sears M R, Mink S, Chung K, Lee J
机构信息
Respiratory Medicine, Center for Clinical Epidemiology and Evaluation, University of British Columbia, Vancouver General Hospital Research Pavilion, 822 West 10th Avenue, Vancouver, BC, Canada V5Z 1L8.
出版信息
Thorax. 2004 Jul;59(7):550-6. doi: 10.1136/thx.2003.014936.
BACKGROUND
Previous guidelines recommend doubling the daily dose of maintenance inhaled corticosteroid to treat or prevent progression of exacerbations of asthma.
METHODS
Over a 6 month period a cohort of patients were evaluated prospectively and randomised in a double blind controlled trial to treatment with either a continued maintenance dose (MD) of inhaled corticosteroid or doubling the dose (DD) at the time of an exacerbation.
RESULTS
A total of 290 patients were randomised (33% male) and 98 (DD, n = 46) experienced evaluable asthma exacerbations during the study period. Mean (SD) baseline characteristics at randomisation (age 33.5 (14.0) years; forced expiratory volume in 1 second (FEV(1)) 2.8 (0.7) l; peak expiratory flow (PEF) 422.9 (110.5) l/min) were similar in both groups. In the DD group 41% of patients were considered treatment failures because they either required systemic steroids (n = 12), had an unscheduled visit to a physician (n = 1), or their asthma did not return to baseline (n = 6). This did not differ from the MD group in which 40% were treatment failures (n = 9, 0, and 12, respectively; p = 0.94).
CONCLUSIONS
In patients who regularly take an inhaled corticosteroid, doubling the maintenance dose may not affect the pattern of the exacerbation.
背景
既往指南建议将维持吸入性糖皮质激素的日剂量加倍，以治疗或预防哮喘加重的进展。
方法
在6个月的时间里，对一组患者进行前瞻性评估，并在双盲对照试验中随机分为两组，一组继续使用维持剂量（MD）的吸入性糖皮质激素治疗，另一组在哮喘加重时将剂量加倍（DD）。
结果
共有290例患者被随机分组（男性占33%），98例（DD组，n = 46）在研究期间经历了可评估的哮喘加重。两组随机分组时的平均（标准差）基线特征相似（年龄33.5（14.0）岁；第1秒用力呼气量（FEV₁）2.8（0.7）升；呼气峰值流速（PEF）422.9（110.5）升/分钟）。在DD组中，41%的患者被视为治疗失败，原因是他们要么需要全身使用类固醇（n = 12），要么非计划就诊（n = 1），要么哮喘未恢复到基线水平（n = 6）。这与MD组无差异，MD组中40%为治疗失败（分别为n = 9、0和12；p = 0.94）。
结论
在定期使用吸入性糖皮质激素的患者中，将维持剂量加倍可能不会影响哮喘加重的模式。
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