Bathoorn Erik, Liesker Jeroen J W, Postma Dirkje S, Boorsma Martin, Bondesson Eva, Koëter Gerard H, Kauffman Henk F, van Oosterhout Antoon J M, Kerstjens Huib A M
Groningen Research Institute for Asthma and COPD, Department of Pulmonology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
COPD. 2008 Oct;5(5):282-90. doi: 10.1080/15412550802363360.
Systemic corticosteroids and additional short-acting beta2-agonists are commonly used in exacerbations of chronic obstructive pulmonary disease (COPD). In this double-blind study, the combination of a high-dose inhaled corticosteroid with a rapid-onset long-acting beta2-agonist was evaluated in the treatment of out-patient COPD exacerbations. The primary aim was to compare 14-day treatment effects of budesonide/formoterol to placebo on sputum eosinophils and, secondarily, on other indices of inflammation, forced expiratory flow in one second (FEV(1)), symptoms, health status, and adverse events. Forty-five patients not using steroids (37 male, 21/24 current/ex smoker, median packyears 38, age 65 years, FEV(1) 61% predicted), experiencing a COPD exacerbation, were treated at home with budesonide/formoterol (320/9 microg 4 times daily), prednisolone (30 mg daily), or placebo for 14 days. Sputum eosinophils were significantly reduced by budesonide/formoterol (-57%) compared to placebo (+24%) (p = 0.01). Budesonide/formoterol reduced total symptom scores significantly (p = 0.01) compared to placebo. The increase in FEV(1) by 2 weeks of treatment with budesonide/formoterol (125 ml) was not significantly different from that of placebo (43 ml) (p = 0.07). Budesonide/ formoterol treatment did not suppress morning serum cortisol compared to placebo (-16%; p = 0.50). In conclusion, budesonide/formoterol reduces sputum eosinophils and improves symptoms in the treatment of out-patient COPD exacerbations.
全身用糖皮质激素和额外的短效β2受体激动剂常用于慢性阻塞性肺疾病（COPD）急性加重期。在这项双盲研究中，评估了高剂量吸入性糖皮质激素与快速起效的长效β2受体激动剂联合使用治疗门诊COPD急性加重期的效果。主要目的是比较布地奈德/福莫特罗与安慰剂对痰嗜酸性粒细胞的14天治疗效果，其次是对其他炎症指标、一秒用力呼气容积（FEV₁）、症状、健康状况和不良事件的治疗效果。45名未使用类固醇的患者（37名男性，21/24名当前吸烟者/既往吸烟者，吸烟包年数中位数为38，年龄65岁，FEV₁为预测值的61%），因COPD急性加重在家接受布地奈德/福莫特罗（320/9微克，每日4次）、泼尼松龙（每日30毫克）或安慰剂治疗14天。与安慰剂组（增加24%）相比，布地奈德/福莫特罗组痰嗜酸性粒细胞显著减少（-57%）（p = 0.01）。与安慰剂相比，布地奈德/福莫特罗显著降低了总症状评分（p = 0.01）。布地奈德/福莫特罗治疗2周使FEV₁增加125毫升，与安慰剂组增加43毫升相比，差异无统计学意义（p = 0.07）。与安慰剂相比，布地奈德/福莫特罗治疗并未抑制晨间血清皮质醇水平（-16%；p = 0.50）。总之，布地奈德/福莫特罗在治疗门诊COPD急性加重期时可减少痰嗜酸性粒细胞并改善症状。
