Obase Yasushi, Ikeda Masaki, Kurose Koji, Abe Masaaki, Shimizu Hiroki, Ohue Yoshihiro, Mouri Keiji, Katoh Shigeki, Kobashi Yoshihiro, Oka Mikio
Department of Respiratory Medicine, Kawasaki Medical School, Matsushima, Kurashiki, Japan.
J Asthma. 2013 Sep;50(7):718-21. doi: 10.3109/02770903.2013.795588. Epub 2013 Jun 18.
Administration of the combination of an inhaled corticosteroid (ICS) and a long-acting beta agonist (LABA) is the main treatment strategy for bronchial asthma. The ICS/LABA dosage can be reduced (stepped down) when the patient's symptoms and lung functions are well-controlled. In this study, we obtained fractional exhaled nitric oxide (FeNO) measurements to clarify whether the anti-inflammatory effect of budesonide/formoterol is shortened by step-down.
Fifty-four patients who visited the Kawasaki Medical School Hospital with newly diagnosed asthma from November 2008 to July 2010 received budesonide/formoterol for 8 weeks or more. In 29 patients, the forced expiratory volume in 1 s% predicted increased to 80% or more, and the Asthma Control Questionnaire (ACQ) score decreased to 0.5 or less within 12 weeks. These 29 patients were randomly divided into two groups: the dosage-continued group (n = 14) and the step-down group (n = 15). Then, the impact of budesonide/formoterol step-down on ACQ score, pulmonary function and FeNO level was compared between the groups.
In the step-down group, the dosage was stepped down from 538 mcg/day to 331 mcg/day. In both groups, pulmonary function indicators and symptoms did not change. However, the mean FeNO level decreased significantly in the dosage-continued group (from 50.9 ppb to 45.0 ppb), and increased significantly in the step-down group (from 51.0 ppb to 65.7 ppb).
Clinicians should be more careful when stepping down budesonide/formoterol based solely on patients' symptoms and/or pulmonary function.
吸入性糖皮质激素（ICS）与长效β受体激动剂（LABA）联合使用是支气管哮喘的主要治疗策略。当患者症状和肺功能得到良好控制时，ICS/LABA剂量可减少（逐步减量）。在本研究中，我们通过测量呼出一氧化氮分数（FeNO）来明确布地奈德/福莫特罗的抗炎作用是否会因逐步减量而缩短。
2008年11月至2010年7月，54例新诊断为哮喘并前往川崎医科大学医院就诊的患者接受布地奈德/福莫特罗治疗8周或更长时间。其中29例患者在12周内1秒用力呼气容积占预计值百分比增加至80%或更高，哮喘控制问卷（ACQ）评分降至0.5或更低。这29例患者被随机分为两组：剂量持续组（n = 14）和逐步减量组（n = 15）。然后，比较两组之间布地奈德/福莫特罗逐步减量对ACQ评分、肺功能和FeNO水平的影响。
在逐步减量组中，剂量从538微克/天降至331微克/天。两组的肺功能指标和症状均未改变。然而，剂量持续组的平均FeNO水平显著降低（从50.9 ppb降至45.0 ppb），而逐步减量组则显著升高（从51.0 ppb升至65.7 ppb）。
临床医生在仅根据患者症状和/或肺功能对布地奈德/福莫特罗进行逐步减量时应更加谨慎。
