Derrica Y. Walker is a 2014 Pharm.D candidate; and Krystal L. Edwards, Pharm.D., FCCP, BCPS, is Associate Professor, Department of Pharmacy Practice, School of Pharmacy, Texas Tech University Health Sciences Center, Dallas.
Am J Health Syst Pharm. 2013 Oct 1;70(19):1661-9. doi: 10.2146/ajhp120680.
Current evidence on statin agents as potential alternatives or adjuncts to corticosteroid therapy for asthma is reviewed.
Research showing antiinflammatory and antioxidant effects of statins in animal models suggested that the cholesterol-lowering drugs might be useful in mitigating the adverse effects of long-term corticosteroid therapy in patients with asthma, but studies in humans have yielded mixed results. Two small placebo-controlled clinical trials indicated that statins were not effective in combating asthmatic inflammatory processes, and trials of statins as adjunctive therapy have indicated minimal steroid-sparing benefits. In two studies involving a total of more than 1000 current and former smokers with asthma, statin use correlated with reduced acute asthma exacerbations and a slower decline of lung function in some patients. A large population-based study (n = 3965) found that statin therapy was associated with a significantly reduced risk of hospitalization for asthma after an average follow-up period of about 4.5 years; a smaller U.S. retrospective cohort study indicated a significantly lower 1-year rate of asthma-related emergency room visits among patients receiving statins relative to those not using statins (9.08% versus 4.18%). Much of the research on statins and asthma has not controlled for confounding influences such as patient comorbidities and concomitant medication use.
Clinical trials have shown that statin therapy is not superior to and does not enhance the beneficial effects of inhaled corticosteroids for the treatment of asthma. Some evidence suggests that statins may help preserve lung function in cigarette smokers with obstructive pulmonary disease and reduce hospitalizations in asthmatic smokers and nonsmokers.
本文回顾了他汀类药物作为哮喘皮质类固醇治疗替代或辅助药物的现有证据。
他汀类药物在动物模型中具有抗炎和抗氧化作用的研究结果表明，这些降胆固醇药物可能有助于减轻哮喘患者长期皮质类固醇治疗的不良反应，但人体研究得出的结果喜忧参半。两项小型安慰剂对照临床试验表明，他汀类药物在对抗哮喘炎症过程方面无效，他汀类药物作为辅助治疗的试验表明，其对减少类固醇的益处微乎其微。在两项共涉及超过 1000 名当前和曾经吸烟的哮喘患者的研究中，他汀类药物的使用与急性哮喘加重的减少和一些患者肺功能下降速度的减慢相关。一项基于人群的大型研究（n = 3965）发现，在平均约 4.5 年的随访后，他汀类药物治疗与哮喘住院风险显著降低相关；一项较小的美国回顾性队列研究表明，与未使用他汀类药物的患者相比，使用他汀类药物的患者在一年内因哮喘相关急诊就诊的比率显著降低（9.08%对 4.18%）。他汀类药物与哮喘的大部分研究并未控制混杂因素的影响，如患者合并症和同时使用的药物。
临床试验表明，他汀类药物治疗并不优于吸入皮质类固醇治疗哮喘，也不能增强其疗效。一些证据表明，他汀类药物可能有助于维持吸烟的阻塞性肺疾病患者的肺功能，并减少哮喘吸烟和非吸烟患者的住院治疗。
