Miyahara Hiroaki, Korematsu Seigo, Nagakura Tomokazu, Izumi Tatsuro
Department of Brain and Nerve Science, , Oita University Faculty of Medicine, Yufu, Oita, Japan.
Pediatr Int. 2008 Feb;50(1):103-8. doi: 10.1111/j.1442-200X.2007.02523.x.
For the treatment of bronchial asthma, two types of fluticasone inhaler devices are available, namely, metered-dose inhaler with spacer (MDI-S) and the dry powder inhaler (DPI). The former is recommended for young children with a low peak inspiratory flow (PIF) and the latter for adolescents and adults. But the difference in the therapeutic efficacy between them has been studied only rarely in adolescent patients.
In the present study, 21 post-elementary school-age patients with moderate persistent bronchial asthma (age 8-15 years, 10.3 +/- 2.1 years), who all had a sufficient PIF of 114 +/- 29 L/min, were examined in order to compare the two types of fluticasone inhalers. Eleven of 21 patients inhaled 200 microg/day Flutide using the MDI-S twice daily for 1 month in the first month, and the same dose using the DPI for the next month. The other 10 patients inhaled the opposite regimens. At the end of the each treatment, spirometry was examined.
Measurements done before therapy and then at the end of MDI-S and DPI therapy, respectively, were as follows: forced expiratory volume in 1 s (FEV(1.0)), 72.4 +/- 18.2%, 91.5 +/- 18.2% and 84.1 +/- 16.3% (MDI-S vs DPI, P > 0.040); maximal mid-expiratory flow (MMEF), 62.0 +/- 23.6%, 88.7 +/- 26.5%, 79.3 +/- 33.4% (P > 0.044) and the peak expiratory flow (PEF) was 73.9 +/- 25.0%, 95.6 +/- 32.8%, and 90.5 +/- 29.5%, respectively (n.s.). MDI-S was thus found to be more effective in terms of %FEV(1.0) and in %MMEF.
High therapeutic efficacy was obtained with the use of the MDI-S in fluticasone inhalation for post-elementary school-age patients with sufficient inspiration ability.
用于治疗支气管哮喘的氟替卡松吸入装置有两种，即带储雾罐的定量气雾剂（MDI-S）和干粉吸入器（DPI）。前者推荐用于吸气峰流速（PIF）较低的幼儿，后者用于青少年和成人。但在青少年患者中，它们之间治疗效果的差异很少被研究。
在本研究中，对21名小学毕业后患有中度持续性支气管哮喘的患者（年龄8 - 15岁，平均10.3±2.1岁）进行检查，以比较两种氟替卡松吸入器，所有患者的PIF均足够，为114±29升/分钟。21名患者中的11名在第一个月每天使用MDI-S吸入200微克/天氟替卡松，每日两次，共1个月，在下个月使用DPI吸入相同剂量。另外10名患者吸入相反的方案。在每次治疗结束时，进行肺功能测定。
治疗前以及MDI-S和DPI治疗结束时的测量结果如下：第1秒用力呼气量（FEV(1.0)）分别为72.4±18.2%、91.5±18.2%和84.1±16.3%（MDI-S与DPI相比，P>0.040）；最大呼气中期流速（MMEF）分别为62.0±2 /span>3.6%、88.7±26.5%、79.3±33.4%（P>0.044），呼气峰值流速（PEF）分别为73.9±25.0%、95.6±32 /span>.8%和90.5±29.5%（无显著差异）。因此发现MDI-S在%FEV(1.0)和%MMEF方面更有效。
对于有足够吸气能力的小学毕业后患者，使用MDI-S吸入氟替卡松可获得较高的治疗效果。
