Skin and Allergy Hospital, Helsinki University Central Hospital, Helsinki, Finland.
J Allergy Clin Immunol. 2009 Dec;124(6):1180-5. doi: 10.1016/j.jaci.2009.09.036.
In a 3-year study, adult patients who recently developed asthma (symptoms for less than 1 year) were treated for 2 years with the inhaled corticosteroid (ICS) budesonide (early therapy) or terbutaline. During the third year of the study, terbutaline-treated patients received budesonide (delayed therapy). Differences in lung function and bronchial responsiveness to histamine were observed between the 2 groups.
We compared the effects of early versus delayed budesonide therapy after a 10-year follow-up period (13 years after the study began) and current real-life data.
Of the original 103 patients, 90 were re-examined 13 years after study initiation. After the third year of the study, all patients had their medications, including the dose of ICS, individually adjusted.
After the follow-up period, lung function was within the normal range for the entire group (all patients); bronchial responsiveness significantly improved compared with baseline data. No statistically significant differences in clinical or functional variables were found between patients given early or delayed budesonide therapy. However, the delayed therapy group had a higher neutrophil count and higher concentrations of eosinophilic cationic protein and myeloperoxidase in induced sputum. This group had also used more asthma medication and hospital days.
Patients with relatively mild asthma who received ICS within 12 months of their first asthma symptoms or after a 2-year delay achieved equally good functional control of asthma after 10 years of individualized therapy. However, the delayed therapy group exhibited slightly less optimal disease control and more signs of airway inflammation.
在一项为期 3 年的研究中，近期诊断为哮喘（症状持续时间少于 1 年）的成年患者接受了 2 年的吸入皮质激素（ICS）布地奈德（早期治疗）或特布他林治疗。在研究的第 3 年，特布他林治疗的患者接受了布地奈德（延迟治疗）。两组患者的肺功能和支气管对组胺的反应性存在差异。
我们比较了早期与延迟布地奈德治疗在 10 年随访期（研究开始后 13 年）和当前真实世界数据中的效果。
在原始的 103 名患者中，90 名在研究开始后 13 年接受了重新检查。在研究的第 3 年后，所有患者都根据个人情况调整了药物，包括 ICS 的剂量。
在随访期后，整个组的肺功能都在正常范围内（所有患者）；与基线数据相比，支气管反应性显著改善。在接受早期或延迟布地奈德治疗的患者之间，未发现临床或功能变量存在统计学差异。然而，延迟治疗组的中性粒细胞计数较高，诱导痰中的嗜酸性阳离子蛋白和髓过氧化物酶浓度也较高。该组还使用了更多的哮喘药物和住院天数。
在首次哮喘症状后 12 个月内或延迟 2 年后接受 ICS 的轻度哮喘患者，在接受个体化治疗 10 年后，对哮喘的功能控制同样良好。然而，延迟治疗组的疾病控制稍差，气道炎症的迹象更多。
