单次丙酸氟替卡松给药后气道对腺苷的反应性可区分哮喘和 COPD。

Airway responsiveness to adenosine after a single dose of fluticasone propionate discriminates asthma from COPD.

机构信息

Dipartimento di Medicina Interna e Specialistica, Sez. Malattie Apparato Respiratorio, Università di Catania, Catania, Italy.

Dept of Cardiovascular and Respiratory Studies, Hull York Medical School, University of Hull, Castle Hill Hospital, Cottingham, UK.

出版信息

Pulm Pharmacol Ther. 2014 Feb;27(1):70-5. doi: 10.1016/j.pupt.2013.05.002. Epub 2013 May 18.

DOI:10.1016/j.pupt.2013.05.002

PMID:23688422

Abstract

BACKGROUND

Regular treatment with inhaled corticosteroids (ICS) is known to reduce airway hyperresponsiveness (AHR) to adenosine 5'-monophosphate (AMP) in asthma even after a single dose of fluticasone propionate (FP).

AIM

To determine whether this rapid protective effect of a single dose of FP is also present in COPD.

METHODS

23 mild asthmatic and 24 COPD subjects with documented AHR to both AMP and methacholine took part in a randomized, double-blind, placebo-controlled, crossover study to measure AHR to inhaled AMP and methacholine 2 h after either 1000 μg FP or matched placebo.

RESULTS

In subjects with asthma, 1000 μg FP in a single dose significantly attenuated the constrictor response to AMP, geometric mean (range) PC20AMP values increasing from a 19.2 (1.3-116.3) to 81.5 (9.6-1600.0) (p < 0.001; post-placebo vs post-FP) mg/ml. Change in the airways response to inhaled AMP after FP was well within test variability in patients with COPD, with PC20AMP values 59.6 (11.3-183.9) and 76.3 (21.0-445.3) (p = 0.022; post-placebo vs post-FP) mg/ml. Additionally, FP failed to significantly attenuate the bronchial response to methacholine in both asthma and COPD subjects. A change in doubling dilution, between placebo and following a single dose of FP, in AMP had a better sensitivity and specificity of 95.8% and 65.2%, compared to methacholine of 79.2% and 43.5% respectively in delineating between COPD and asthma.

CONCLUSION

A single dose of 1000 μg FP rapidly improves AHR to AMP in asthmatics but not in COPD subjects. This may provide a convenient way by which provocation challenge with inhaled AMP may help in discriminating asthma from COPD.

摘要

背景

已知吸入性皮质类固醇（ICS）的常规治疗可降低哮喘患者对腺苷 5'-单磷酸（AMP）的气道高反应性（AHR），即使在单次丙酸氟替卡松（FP）给药后也是如此。

目的

确定 COPD 患者中是否也存在 FP 单次剂量的这种快速保护作用。

方法

23 例轻度哮喘和 24 例 COPD 患者均记录到 AMP 和乙酰甲胆碱的 AHR，参与了一项随机、双盲、安慰剂对照、交叉研究，以测量吸入 AMP 和乙酰甲胆碱后 2 小时的 AHR。在接受 1000μg FP 或匹配安慰剂后。

结果

在哮喘患者中，单次 1000μg FP 可显著减轻 AMP 的收缩反应，几何平均（范围）PC20AMP 值从 19.2（1.3-116.3）增加到 81.5（9.6-1600.0）（p<0.001；后安慰剂与后 FP）mg/ml。FP 后气道对吸入 AMP 的反应变化在 COPD 患者的测试变异性范围内，PC20AMP 值为 59.6（11.3-183.9）和 76.3（21.0-445.3）（p=0.022；后安慰剂与后 FP）mg/ml。此外，FP 未能显著减轻哮喘和 COPD 患者对乙酰甲胆碱的支气管反应。与 FP 单次剂量相比，AMP 的倍增稀释变化在区分 COPD 和哮喘方面具有 95.8%和 65.2%的更好敏感性和特异性，而乙酰甲胆碱的敏感性和特异性分别为 79.2%和 43.5%。