Belda J, Margarit G, Martínez C, Bellido-Casado J, Casan P, Torrejón M, Brufal M, Rodríguez-Jerez F, Sanchis J
Departament de Pneumologia, Clínica d'Asma i allèrgia, Hospital de la Santa Creu i de Sant Pau, Universitat Autònoma de Barcelona, Spain.
Eur Respir J. 2007 Dec;30(6):1143-9. doi: 10.1183/09031936.00050306. Epub 2007 Aug 9.
The objective of the present study was to investigate the kinetics of high doses of inhaled steroid fluticasone in comparison with oral steroid prednisone on plasma protein leakage and bronchial eosinophilia in adults with moderate asthma exacerbations. The study design was a randomised, double-blind, placebo-controlled prospective trial. In total, 45 patients treated at the emergency department for moderate asthma exacerbations were recruited and 39 were assigned to receive fluticasone and placebo of prednisone (19 patients), or prednisone and placebo of fluticasone (20 patients). Medication was administered to all patients via a metered-dose inhaler and spacer (16 puffs; 4,000 microg.day(-1) or placebo) plus one pill (prednisone 30 mg.day(-1) or placebo). Spirometry and induced sputum for differential cell counts, albumin and alpha(2)-macroglobulin levels and blood eosinophils, interleukin-5 and granulocyte-macrophage colony-stimulating factor levels were obtained before treatment and at 2, 6 and 24 h after treatment. Symptoms clearly improved after 24 h in both groups. No differences were seen between groups in peak expiratory flow or forced expiratory flow in one second, which improved progressively but then decayed slightly after 24 h. Eosinophil counts in sputum also improved over time in both groups. The effect was faster with fluticasone than with prednisone, but was partially lost at 24 h. However, plasma proteins in sputum and eosinophil count in blood both decreased until 24 h, with no significant differences between groups. There was no correlation between eosinophil counts and plasmatic protein levels. In conclusion, both treatments improved symptoms, airway obstruction and inflammation, and plasma protein leakage at 24 h. Prednisone reduced blood eosinophil counts, while fluticasone reduced airway eosinophil counts, suggesting that the anti-inflammatory performance of fluticasone is exerted locally.
本研究的目的是比较高剂量吸入性类固醇氟替卡松与口服类固醇泼尼松对中度哮喘加重期成人血浆蛋白渗漏和支气管嗜酸性粒细胞增多的动力学影响。研究设计为随机、双盲、安慰剂对照的前瞻性试验。总共招募了45名在急诊科接受中度哮喘加重期治疗的患者，其中39名被分配接受氟替卡松和泼尼松安慰剂（19名患者），或泼尼松和氟替卡松安慰剂（20名患者）。所有患者均通过定量吸入器和储雾罐给药（16喷；4000微克·天⁻¹或安慰剂）加一片药丸（泼尼松30毫克·天⁻¹或安慰剂）。在治疗前以及治疗后2、6和24小时进行肺活量测定，并采集诱导痰进行细胞分类计数、白蛋白和α₂-巨球蛋白水平检测，同时检测血液嗜酸性粒细胞、白细胞介素-5和粒细胞-巨噬细胞集落刺激因子水平。两组患者在24小时后症状均明显改善。两组之间在呼气峰值流速或一秒用力呼气流量方面没有差异，这些指标逐渐改善，但在24小时后略有下降。两组痰中嗜酸性粒细胞计数也随时间改善。氟替卡松的效果比泼尼松更快，但在24小时时部分消失。然而，痰中血浆蛋白和血液嗜酸性粒细胞计数在24小时前均下降，两组之间没有显著差异。嗜酸性粒细胞计数与血浆蛋白水平之间没有相关性。总之，两种治疗方法均改善了症状、气道阻塞和炎症以及24小时时的血浆蛋白渗漏。泼尼松降低了血液嗜酸性粒细胞计数，而氟替卡松降低了气道嗜酸性粒细胞计数，这表明氟替卡松的抗炎作用是在局部发挥的。
