Cardiothoracic and Vascular Department, University of Pisa, Pisa, Italy.
Ann Allergy Asthma Immunol. 2010 Jun;104(6):464-70. doi: 10.1016/j.anai.2010.04.003.
Severe asthma occurs in a heterogeneous group of patients in whom symptoms and airway inflammation persist despite maximal antiasthma treatment.
To verify whether a short-term course of oral steroids would modify sputum inflammatory cytokine and sputum eosinophil concentrations and whether this effect is related to the presence of sputum eosinophilia.
In 59 patients with severe refractory asthma, we measured pulmonary function and inflammatory markers in hypertonic saline-induced sputum before and after 2 weeks of treatment with 0.5 mg/kg of oral prednisone (n = 39) or placebo (n = 20) daily. Selected sputum portions were assayed for total and differential cell counts and supernatant interleukin (IL) 5 and IL-8 concentrations.
At baseline, no statistical differences were found among placebo- and prednisone-treated patients in terms of sputum inflammatory cell percentages and IL-5 and IL-8 concentrations. After treatment, forced expiratory volume in 1 second significantly increased and sputum eosinophil percentages and IL-5 and IL-8 concentrations significantly decreased in the prednisone group, whereas no changes were observed in the placebo group. The positive effect of prednisone treatment was observed only in patients with baseline sputum eosinophilia, whereas in noneosinophilic patients with severe asthma prednisone induced only a significant decrease of sputum IL-8.
Additional high-dose oral corticosteroids improve pulmonary function and reduce not only sputum eosinophil but also sputum proinflammatory cytokine concentrations in patients with severe refractory asthma.
严重哮喘发生于一组异质性患者，尽管给予最大剂量的哮喘治疗，其症状和气道炎症仍持续存在。
验证短期口服类固醇治疗是否会改变痰中炎症细胞因子和痰嗜酸性粒细胞浓度，以及这种作用是否与痰嗜酸性粒细胞增多有关。
在 59 例严重难治性哮喘患者中，我们在每日口服 0.5mg/kg 泼尼松龙（n=39）或安慰剂（n=20）2 周前后，通过高渗盐水诱导的痰测量肺功能和炎症标志物。对选定的痰部分进行总细胞和分类细胞计数以及上清液白细胞介素（IL）5 和 IL-8 浓度的检测。
在基线时，接受安慰剂和泼尼松龙治疗的患者在痰炎症细胞百分比、IL-5 和 IL-8 浓度方面无统计学差异。治疗后，泼尼松组用力呼气量在 1 秒内显著增加，痰嗜酸性粒细胞百分比以及 IL-5 和 IL-8 浓度显著降低，而安慰剂组无变化。泼尼松治疗的阳性效果仅在基线时有痰嗜酸性粒细胞增多的患者中观察到，而在无嗜酸性粒细胞的严重哮喘患者中，泼尼松仅引起痰 IL-8 的显著降低。
额外的高剂量口服皮质类固醇可改善肺功能，并降低严重难治性哮喘患者痰中不仅是嗜酸性粒细胞，而且是促炎细胞因子的浓度。
