环索奈德剂量和治疗持续时间对哮喘患者运动诱发性支气管收缩的影响。

Effect of ciclesonide dose and duration of therapy on exercise-induced bronchoconstriction in patients with asthma.

作者信息

Subbarao Padmaja, Duong Mylinh, Adelroth Ellinor, Otis Joceline, Obminski George, Inman Mark, Pedersen Soren, O'byrne Paul M

机构信息

Hospital for Sick Children, University of Toronto, Ontario, Canada.

出版信息

J Allergy Clin Immunol. 2006 May;117(5):1008-13. doi: 10.1016/j.jaci.2005.11.048.

DOI:10.1016/j.jaci.2005.11.048

PMID:16675326

Abstract

BACKGROUND

Inhaled corticosteroid therapy improves exercise symptoms in asthmatic subjects.

OBJECTIVE

We sought to evaluate exercise-induced bronchoconstriction (EIB) as a method of determining the dose and time responses of inhaled corticosteroid therapy.

METHODS

In this double-blind, randomized, cross-over study with 2 parallel arms, 4 doses of inhaled ciclesonide (40 microg and 160 microg or 80 microg and 320 microg) were compared over 3 weeks of treatment. Twenty-six asthmatic subjects (age range, 14-27 years) with baseline FEV1 values of greater than 70% of predicted value were enrolled. The primary outcome was the maximum percentage decrease in FEV1 after standardized exercise challenge.

RESULTS

After 1 week of therapy, the mean +/- SEM reduction in maximum decrease in FEV1 in the ciclesonide 40-microg/80-microg dose group was 9% +/- 2.6% (95% CI, 3.9% to 14%), with no additional reduction thereafter. In the ciclesonide 160-microg/320-microg dose group, there was an 8.7% +/- 2.5% (95% CI, 3.7% to 13.7%) reduction in maximum decrease in FEV1 after week 1, which continued in a linear fashion during subsequent weeks of treatment. No difference was found between the 2 treatment arms in the temporal response of EIB to ciclesonide treatment. The maximum percentage attenuation in EIB achieved was 51.1% +/- 7.9%, which was achieved by using the 320-microg dose after 3 weeks of treatment.

CONCLUSIONS

A significant improvement in EIB was demonstrated for all doses of ciclesonide. Use of 160 microg/320 microg of ciclesonide resulted in a continuing improvement in FEV1 with time, and no plateau was seen in protective effect during 3 weeks of treatment.

CLINICAL IMPLICATIONS

Attenuation in exercise-induced decrease can be seen as early as after 1 week of therapy with inhaled ciclesonide at doses greater than 40 microg. However, maximal attenuation in exercise response continues to increase at doses greater than or equal to 200 microg, even after 3 weeks of therapy.

摘要

背景

吸入性糖皮质激素疗法可改善哮喘患者的运动症状。

目的

我们试图评估运动诱发性支气管收缩（EIB）作为一种确定吸入性糖皮质激素疗法剂量和时间反应的方法。

方法

在这项具有两个平行组的双盲、随机、交叉研究中，在3周的治疗期间比较了4种剂量的吸入用环索奈德（40微克和160微克或80微克和320微克）。纳入了26名哮喘患者（年龄范围14 - 27岁），其基线第一秒用力呼气容积（FEV1）值大于预测值的70%。主要结局是标准化运动激发后FEV1的最大下降百分比。

结果

治疗1周后，环索奈德40微克/80微克剂量组FEV1最大下降的平均±标准误减少为9%±2.6%（95%可信区间，3.9%至14%），此后无进一步减少。在环索奈德160微克/320微克剂量组，第1周后FEV1最大下降减少了8.7%±2.5%（95%可信区间，3.7%至13.7%），在随后的治疗周中呈线性持续下降。在EIB对环索奈德治疗的时间反应方面，两个治疗组之间未发现差异。EIB达到的最大百分比衰减为51.1%±7.9%，这是在治疗3周后使用320微克剂量实现的。