Riemersma Roland A, Postma Dirkje, van der Molen Thys
Department of General Practice, University Medical Center Groningen, Groningen, The Netherlands.
Prim Care Respir J. 2012 Mar;21(1):50-6. doi: 10.4104/pcrj.2011.00090.
The management of asthma has changed since the introduction of budesonide/formoterol (Symbicort®) as both maintenance and reliever therapy (SMART). SMART and its effects on bronchial hyperresponsiveness (BHR) have not been studied in primary care.
To compare the effects of SMART and guideline-driven usual care (UC) on BHR and clinical asthma severity in primary care practice.
Patients with mild-to-moderate stable asthma were randomised to receive SMART treatment (n=54) (budesonide/formoterol 80/4.5 μg Turbuhaler®, two puffs once daily and extra inhalations as needed) or UC treatment (n=48) for 12 months. Diary data, Asthma Control Questionnaire scores, forced expiratory volume in 1 second (FEV1), and peak expiratory flow (PEF) measurements were collected during run-in and after 1, 3, 6, and 12 months of treatment. BHR, measured as the dose of histamine provoking a fall in FEV1 of 20% (PD20-histamine), was determined at randomisation and after 12 months.
One hundred and two patients with asthma participated in the study. The change in PD20-histamine during the study was not significantly different between the SMART and UC groups (p=0.26). The mean inhaled corticosteroid (ICS) dose was 326 μg beclomethasone dipropionate (BDP) equivalents/day (95% CI 254 to 399) with SMART, which was significantly lower (p<0.0001) than the mean ICS dose with UC treatment (798 μg BDP equivalents/day (95% CI 721 to 875). Morning and evening PEF values increased significantly with SMART treatment compared with UC; FEV1, symptoms and asthma control did not differ.
Despite a 59% lower dose of ICS, BHR and other clinical outcomes remained stable during SMART treatment while PEF values improved.
自布地奈德/福莫特罗（信必可都保®）作为维持和缓解治疗（SMART）应用以来，哮喘的管理方式发生了变化。SMART及其对支气管高反应性（BHR）的影响在初级保健中尚未得到研究。
比较SMART和指南驱动的常规治疗（UC）对初级保健实践中BHR和临床哮喘严重程度的影响。
将轻至中度稳定哮喘患者随机分为接受SMART治疗组（n = 54）（布地奈德/福莫特罗80/4.5μg都保®，每日一次两吸，并根据需要额外吸入）或UC治疗组（n = 48），为期12个月。在导入期以及治疗1、3、6和12个月后收集日记数据、哮喘控制问卷评分、一秒用力呼气量（FEV1）和呼气峰值流速（PEF）测量值。BHR以激发FEV1下降20%的组胺剂量（PD20 -组胺）来衡量，在随机分组时和12个月后进行测定。
102例哮喘患者参与了该研究。研究期间，SMART组和UC组的PD20 -组胺变化无显著差异（p = 0.26）。SMART组吸入糖皮质激素（ICS）的平均剂量为326μg丙酸倍氯米松（BDP）等效物/天（95%可信区间254至399），显著低于UC治疗组的ICS平均剂量（798μg BDP等效物/天（95%可信区间721至875））（p < 0.0001）。与UC相比，SMART治疗使早晚PEF值显著增加；FEV1、症状和哮喘控制情况无差异。
尽管ICS剂量降低了59%，但在SMART治疗期间BHR和其他临床结局保持稳定，同时PEF值有所改善。
