Department of Clinical Sciences, University of Parma, Italy.
Allergy Asthma Proc. 2010 Sep-Oct;31(5):85-90. doi: 10.2500/aap.2010.31.3367.
Exhaled nitric oxide (NO) is a noninvasive marker of airway inflammation. Beclomethasone dipropionate (BDP) is the only inhaled corticosteroid (ICS) available as both extrafine and nonextrafine hydrofluoroalkane (HFA) pressurized metered-dose inhaler (pMDI) formulation. The present study was designed to evaluate whether the different patterns of lung deposition of two HFA BDP formulations are associated with a different effect on bronchial and alveolar NO. This was a prospective double-blind, randomized, controlled, crossover study. After a 2-week placebo run-in period without ICSs, asthmatic patients were randomized to extrafine BDP, 100 μg, b.i.d. or nonextrafine BDP, 250 μg, b.i.d. for two 2-week periods separated by a 2-week washout period. Fourteen patients (5 men) with a mean age 37 years and mean baseline forced expiratory volume in 1 second (FEV₁) of 83% of predicted were analyzed. Exhaled bronchial NO was significantly (p < 0.001) reduced in both treatment groups when compared with the last week of run-in period, whereas alveolar NO was significantly (p < 0.001) reduced only with extrafine BDP. Moreover, extrafine BDP was superior to nonextrafine BDP in both parameters (p < 0.05). Extrafine but not nonextrafine BDP HFA formulation lowers both bronchial and alveolar exhaled NO in asthmatic patients. ICS distribution throughout the whole bronchial tree could be important in patients who do not gain optimal control of inflammation with conventional nonextrafine ICS.
呼出气一氧化氮（NO）是气道炎症的一种非侵入性标志物。倍氯米松双丙酸酯（BDP）是唯一一种可同时作为超细和非超细氢氟烷烃（HFA）加压计量吸入器（pMDI）制剂的吸入性皮质类固醇（ICS）。本研究旨在评估两种 HFA BDP 制剂不同的肺部沉积模式是否与支气管和肺泡 NO 产生不同的影响相关。这是一项前瞻性、双盲、随机、对照、交叉研究。经过 2 周的安慰剂洗脱期，不使用 ICS，哮喘患者随机接受超细 BDP，100μg，每日两次，或非超细 BDP，250μg，每日两次，两种治疗方案各持续 2 周，洗脱期为 2 周。共有 14 名（5 名男性）患者平均年龄 37 岁，平均基线 1 秒用力呼气量（FEV₁）占预计值的 83%，纳入分析。与洗脱期最后一周相比，两种治疗组的呼出气支气管 NO 均显著降低（p < 0.001），而肺泡 NO 仅在超细 BDP 治疗组显著降低（p < 0.001）。此外，超细 BDP 在这两个参数上均优于非超细 BDP（p < 0.05）。超细但非非超细 HFA 制剂降低哮喘患者的支气管和肺泡呼出气 NO。在不能通过常规非超细 ICS 获得最佳炎症控制的患者中，ICS 在整个支气管树中的分布可能很重要。
