Spears M, Donnelly I, Jolly L, Brannigan M, Ito K, McSharry C, Lafferty J, Chaudhuri R, Braganza G, Adcock I M, Barnes P J, Wood S, Thomson N C
Faculty of Medicine, University of Glasgow, Glasgow, UK.
Eur Respir J. 2009 May;33(5):1010-7. doi: 10.1183/09031936.00158208. Epub 2009 Feb 5.
Smoking is common in asthma and is associated with worse asthma control and a reduced therapeutic response to corticosteroids. The present authors hypothesised that treating smokers with asthma with low-dose theophylline added to inhaled corticosteroids would enhance steroid sensitivity and thereby improve lung function and symptoms. In a double-blind, parallel group exploratory trial, 68 asthmatic smokers were randomised to one of three treatments for 4 weeks: inhaled beclometasone (200 microg day(-1)), theophylline (400 mg day(-1)) or both treatments combined. Outcome measures included change in lung function and Asthma Control Questionnaire (ACQ) scores. At 4 weeks, theophylline added to inhaled beclometasone produced an improvement in peak expiratory flow (39.9 L min(-1), 95% confidence intervals (CI) 10.9-68.8) and ACQ score (-0.47, 95% CI -0.91- -0.04) and a borderline improvement in pre-bronchodilator forced expiratory volume in one second (mean difference 165 mL, 95% CI -13-342) relative to inhaled corticosteroid alone. Theophylline alone improved the ACQ score (-0.55, 95% CI -0.99- -0.11), but not lung function. In the present pilot study, the combination of low-dose theophylline and inhaled beclometasone produced improvements in both lung function and symptoms in a group of smokers with asthma. Larger trials are required to extend and confirm these findings.
吸烟在哮喘患者中很常见，并且与哮喘控制不佳以及对皮质类固醇的治疗反应降低有关。本文作者推测，对于患有哮喘的吸烟者，在吸入皮质类固醇的基础上加用低剂量氨茶碱进行治疗，会增强类固醇敏感性，从而改善肺功能和症状。在一项双盲、平行组探索性试验中，68名哮喘吸烟者被随机分为三种治疗方案之一，为期4周：吸入倍氯米松（200微克/天）、氨茶碱（400毫克/天）或两种治疗联合使用。观察指标包括肺功能变化和哮喘控制问卷（ACQ）评分。4周时，在吸入倍氯米松基础上加用氨茶碱，相对于单独使用吸入皮质类固醇，呼气峰值流速有所改善（39.9升/分钟，95%置信区间（CI）10.9 - 68.8），ACQ评分有所改善（-0.47，95%CI -0.91 - -0.04），支气管扩张剂使用前一秒用力呼气量有临界改善（平均差值165毫升，95%CI -13 - 342）。单独使用氨茶碱可改善ACQ评分（-0.55，95%CI -0.99 - -0.11），但对肺功能无改善。在本初步研究中，低剂量氨茶碱与吸入倍氯米松联合使用，使一组哮喘吸烟者的肺功能和症状均得到改善。需要进行更大规模的试验来扩展和证实这些发现。
