Ohwada Akihiko, Inami Kei, Onuma Emi, Matsumoto-Yamazaki Mariko, Atsuta Ryo, Takahashi Kazuhisa
Ohwada Clinic, Chiba;
Exp Ther Med. 2011 Jul;2(4):619-623. doi: 10.3892/etm.2011.268. Epub 2011 May 12.
A long-acting β2-agonist (LABA) combined with an inhaled corticosteroid (ICS) is frequently prescribed as initial therapy in steroid-naïve asthma patients because of its effective control of symptoms and improvement of pulmonary function. However, it is unclear which patients will be responsive to LABAs and whether bronchial responsiveness to LABAs is similar to that to short-acting β2-agonists (SABAs) in a clinical setting. Therefore, the goal of the present study was to compare the changes in spirometric parameters after SABA (salbutamol) inhalation to those after 1-month LABA/ICS (salmeterol/fluticasone propionate) therapy. Spirometric changes were evaluated as absolute values, as the percentage of predicted normal values and as the percentage of baseline values after salbutamol inhalation or 1-month LABA/ICS therapy in 45 patients with asthma. Compared to SABA inhalation, LABA/ICS therapy produced significant improvements in forced expiratory volume in 1 sec (FEV1), peak expiratory flow (PEF), forced expiratory flow at 50% of vital capacity expired (FEF50%) from baseline (expressed as the percentage predicted) in all patients. FEV1 and the FEV1/forced vital capacity (FVC) ratio after SABA or LABA/ICS therapy were inversely related to the corresponding baseline values. Analysis of spirometric changes after SABA inhalation showed that FEV1 was the best among spirometric parameters, such as PEF, correlated with responsiveness to LABA/ICS therapy. Reversibility of FEV1 with SABA inhalation predicts the spirometric response to LABA/ICS as initial therapy in patients with bronchial asthma. LABA/ICS therapy had a greater effect on bronchial reversibility in asthmatic patients, compared to SABA inhalation. This suggested that evaluation of bronchial reversibility after LABA/ICS therapy would be superior to that after SABA inhalation.
长效β2受体激动剂（LABA）联合吸入性糖皮质激素（ICS）常用于初治哮喘患者的初始治疗，因其能有效控制症状并改善肺功能。然而，目前尚不清楚哪些患者对LABA有反应，以及在临床环境中，支气管对LABA的反应性是否与对短效β2受体激动剂（SABA）的反应性相似。因此，本研究的目的是比较吸入SABA（沙丁胺醇）后与1个月LABA/ICS（沙美特罗/丙酸氟替卡松）治疗后肺功能参数的变化。在45例哮喘患者中，评估吸入沙丁胺醇或1个月LABA/ICS治疗后肺功能的变化，以绝对值、预测正常值百分比和基线值百分比表示。与吸入SABA相比，LABA/ICS治疗使所有患者的第1秒用力呼气容积（FEV1）、呼气峰值流速（PEF）、肺活量呼出50%时的用力呼气流量（FEF50%）相对于基线水平（以预测值百分比表示）有显著改善。SABA或LABA/ICS治疗后的FEV1和FEV1/用力肺活量（FVC）比值与相应的基线值呈负相关。吸入SABA后肺功能变化分析表明，在PEF等肺功能参数中，FEV1与对LABA/ICS治疗的反应性相关性最佳。吸入SABA后FEV1的可逆性可预测支气管哮喘患者对LABA/ICS初始治疗的肺功能反应。与吸入SABA相比，LABA/ICS治疗对哮喘患者支气管可逆性的影响更大。这表明评估LABA/ICS治疗后的支气管可逆性优于评估吸入SABA后的支气管可逆性。
