Parameswaran K, Fanat A, O'Byrne P M
Firestone Institute for Respiratory Health, St Joseph's Healthcare, and Department of Medicine, McMaster University, Hamilton, Canada.
Allergy. 2006 Jun;61(6):731-6. doi: 10.1111/j.1398-9995.2005.00906.x.
Combination of inhaled steroid and long-acting beta-agonists has synergistic effects in asthma.
To investigate whether nasal corticosteroid and long-acting beta-agonists have synergistic effects on allergen-induced nasal responses.
The effects of intranasal treatment with fluticasone p-MDI (50 microg bid), salmeterol p-MDI (25 microg bid), their combination, and placebo, on nasal symptoms, eosinophil differential cell count and albumin in nasal lavage fluid (measures of inflammation and leakage respectively) and nasal electrical potential difference (measure of epithelial integrity) were studied in 11 atopic subjects with rhinitis, in a randomized, partially-blinded, 4-period, cross-over study. The measurements were made at baseline, at the end of 1 week of treatment, and immediately after a nasal allergen provocation.
Allergen-induced sneeze, postnasal drip and nasal obstruction were significantly reduced by fluticasone, but not by salmeterol. Eosinophil count in postallergen nasal lavage fluid was significantly less after fluticasone (median 1.9%, IQR 4.6) and salmeterol treatment (median 2.5%, IQR 8.5) compared with placebo (median 12.5%, IQR 27.9). Compared with placebo, both fluticasone and salmeterol attenuated allergen-induced change in nasal potential (mean change from baseline -18.5, +0.4 and -7.2% respectively) and the increase in nasal albumin (median 154, 119 and 130 ng/ml respectively). Combination treatment did not have any additional benefits over the individual therapies.
Although salmeterol has anti-inflammatory properties, intranasal salmeterol or its combination with fluticasone do not offer any added benefit over intranasal fluticasone alone for allergen-induced nasal responses.
吸入性糖皮质激素与长效β受体激动剂联合使用对哮喘具有协同作用。
研究鼻用糖皮质激素与长效β受体激动剂对变应原诱导的鼻反应是否具有协同作用。
在11名患有鼻炎的特应性受试者中进行了一项随机、部分盲法、4周期、交叉研究，观察丙酸氟替卡松压力定量吸入器（50微克，每日两次）、沙美特罗压力定量吸入器（25微克，每日两次）、二者联合使用及安慰剂经鼻治疗对鼻症状、嗜酸性粒细胞分类计数以及鼻灌洗液中白蛋白（分别作为炎症和渗漏指标）和鼻电位差（作为上皮完整性指标）的影响。测量在基线、治疗1周结束时以及鼻变应原激发后立即进行。
丙酸氟替卡松可显著减轻变应原诱导的喷嚏、鼻后滴漏和鼻塞，但沙美特罗无此作用。与安慰剂（中位数12.5%，四分位间距27.9）相比，丙酸氟替卡松（中位数1.9%，四分位间距4.6）和沙美特罗治疗后（中位数2.5%，四分位间距8.5）变应原激发后鼻灌洗液中的嗜酸性粒细胞计数显著降低。与安慰剂相比，丙酸氟替卡松和沙美特罗均可减轻变应原诱导的鼻电位变化（相对于基线的平均变化分别为-18.5%、+0.4%和-7.2%）以及鼻白蛋白增加（中位数分别为154、119和130纳克/毫升）。联合治疗相对于单一疗法并无额外益处。
尽管沙美特罗具有抗炎特性，但对于变应原诱导的鼻反应，鼻用沙美特罗或其与丙酸氟替卡松联合使用相对于单独使用鼻用丙酸氟替卡松并无额外益处。
