Division of Respiratory and Critical Care Medicine, National University Hospital, Singapore, Singapore.
Respir Med. 2009 Apr;103(4):614-20. doi: 10.1016/j.rmed.2008.10.009. Epub 2008 Nov 20.
There is a paucity of information on the differential effects of systemic versus inhaled corticosteroids on airway inflammation in patients with acute asthma. This study aimed to evaluate the effects of stopping systemic corticosteroids while maintaining the inhaled corticosteroids (ICS) on airway inflammation, lung function and asthma symptoms in patients who had been discharged from hospital after treatment for severe acute asthma.
Twenty-four adult patients with severe exacerbations of asthma were treated with both oral and inhaled corticosteroids after discharge from hospital. Oral corticosteroids were stopped after 1 week. Spirometry, asthma quality of life questionnaire (AQLQ) score and exhaled nitric oxide (NO) were measured at discharge, 1 week, and 2 weeks after discharge.
Withdrawal of oral corticosteroids resulted in significant rebound in mean exhaled NO by 11.0ppb (95% CI, 4.9-17.1ppb, p<0.001) or 47.7% (95% CI, 22.4-73.1%) despite uninterrupted ICS treatment. The rebound in exhaled NO occurred despite significant improvement in the mean AQLQ score (p=0.006) and frequency of reliever use (p=0.003) and was not associated with significant change in the mean FEV(1) (p=0.64).
In patients discharged from hospital after treatment for asthma exacerbations, withdrawal of oral corticosteroids resulted in increase in exhaled NO levels despite continued ICS treatment.
关于全身皮质类固醇与吸入皮质类固醇对急性哮喘患者气道炎症的差异影响，信息有限。本研究旨在评估在严重急性哮喘治疗后出院的患者停止全身皮质类固醇而维持吸入皮质类固醇（ICS）对气道炎症、肺功能和哮喘症状的影响。
24 例成人严重哮喘发作患者在出院后接受口服和吸入皮质类固醇治疗。口服皮质类固醇在 1 周后停止。在出院时、出院后 1 周和 2 周测量肺活量、哮喘生活质量问卷（AQLQ）评分和呼出一氧化氮（NO）。
尽管持续使用 ICS 治疗，但停用口服皮质类固醇会导致平均呼出气 NO 显著反弹 11.0ppb（95%CI，4.9-17.1ppb，p<0.001）或 47.7%（95%CI，22.4-73.1%）。尽管 AQLQ 评分（p=0.006）和缓解药物使用频率（p=0.003）显著改善，但呼出气 NO 的反弹与平均 FEV（1）无显著变化相关（p=0.64）。
在哮喘加重治疗后出院的患者中，尽管继续使用 ICS 治疗，但停用口服皮质类固醇会导致呼出气 NO 水平升高。
