Adams N P, Jones P W
Department of Respiratory Medicine, Kings College Hospital, Denmark Hill, London SE5 9RS, UK.
Respir Med. 2006 Aug;100(8):1297-306. doi: 10.1016/j.rmed.2006.04.015. Epub 2006 Jun 23.
Inhaled corticosteroids form the cornerstone of treatment for most patients with asthma. A range of compounds are available with a wide range of prescribable doses. In this overview, we summarize the findings from a number of Cochrane systematic reviews that have examined the relative benefits of different doses of beclometasone dipropionate, budesonide and fluticasone propionate when used to treat children and adults. The key findings are that all inhaled corticosteroids demonstrate a dose-response relationship for efficacy measures, but most of the benefit in mild-to-moderate severity disease is gained in the low-to-moderate dose range of each drug. In this group, high doses of fluticasone lead to small improvements in measures of control at the expense of a steep increase in the incidence of oral side-effects. In patients with severe disease who are dependent on oral steroids, there may be appreciable benefit in reducing oral steroids from very high compared with high doses of fluticasone.
吸入性糖皮质激素是大多数哮喘患者治疗的基石。有一系列化合物可供使用，且有多种可处方剂量。在本综述中，我们总结了多项Cochrane系统评价的结果，这些评价研究了不同剂量的二丙酸倍氯米松、布地奈德和丙酸氟替卡松在治疗儿童和成人时的相对益处。主要发现是，所有吸入性糖皮质激素在疗效指标上均呈现剂量反应关系，但在轻度至中度严重程度的疾病中，每种药物的低至中等剂量范围就能带来大部分益处。在这一组中，高剂量的丙酸氟替卡松虽能使控制指标略有改善，但会导致口腔副作用发生率急剧上升。在依赖口服类固醇的重症患者中，与高剂量的丙酸氟替卡松相比，从非常高的剂量减少口服类固醇可能会有明显益处。
