Currie D C, Lueck C, Milburn H J, Harvey C, Longbottom J L, Darbyshire J H, Nunn A J, Cole P J
Department of Thoracic Medicine, National Heart and Lung Institute, Brompton Hospital, London.
Thorax. 1990 Jun;45(6):447-50. doi: 10.1136/thx.45.6.447.
Allergic bronchopulmonary aspergillosis often requires treatment with oral corticosteroids to control the host response to Aspergillus fumigatus. In a double blind study 25 patients with allergic bronchopulmonary aspergillosis taking maintenance oral corticosteroids were randomly allocated to receive 5 mg natamycin or placebo by nebuliser twice daily for one year. The primary aim of the study was to assess the steroid sparing potential of natamycin. Standardised reductions in corticosteroid dosage were therefore undertaken every five weeks, unless clinically contraindicated. Five patients were withdrawn in the first four months: two (1 natamycin, 1 placebo) died, two (1 natamycin, 1 placebo) had suspected drug reactions, and one (natamycin) was non-compliant. The pretreatment characteristics of the 20 patients (10 in each group) who completed the study were similar, 17 (9 natamycin, 8 placebo) having evidence of recent disease activity. At the end of the study prednisolone dose had been reduced by a similar amount in each group (median natamycin 2.25 mg, placebo 2.5 mg). Evidence of disease activity during the study year (transient shadowing on the chest radiograph, blood eosinophilia, or increases in antibodies to A fumigatus, or any combination of these) was observed in similar numbers of patients in each group (5 natamycin, 7 placebo). There was no evidence that natamycin conferred benefit on these patients with allergic bronchopulmonary aspergillosis.
变应性支气管肺曲霉病通常需要口服皮质类固醇进行治疗，以控制宿主对烟曲霉的反应。在一项双盲研究中，25名正在服用维持剂量口服皮质类固醇的变应性支气管肺曲霉病患者被随机分配，通过雾化器每天两次接受5毫克那他霉素或安慰剂治疗，为期一年。该研究的主要目的是评估那他霉素节省类固醇的潜力。因此，除非有临床禁忌，每五周进行一次皮质类固醇剂量的标准化减少。在最初的四个月里，有5名患者退出：2人（1名那他霉素组，1名安慰剂组）死亡，2人（1名那他霉素组，1名安慰剂组）出现疑似药物反应，1人（那他霉素组）不依从。完成研究的20名患者（每组10名）的治疗前特征相似，其中17人（9名那他霉素组，8名安慰剂组）有近期疾病活动的证据。在研究结束时，每组泼尼松龙剂量的减少量相似（那他霉素组中位数为2.25毫克，安慰剂组为2.5毫克）。在研究年度内，每组出现疾病活动证据（胸部X线片上的短暂阴影、血液嗜酸性粒细胞增多或抗烟曲霉抗体增加，或这些情况的任何组合）的患者数量相似（那他霉素组5人，安慰剂组7人）。没有证据表明那他霉素对这些变应性支气管肺曲霉病患者有益。
