Fernandes Ana Luisa Godoy, Amorim Maria Marta, Caetano Lilian Ballini, Dracoulakis Samir, Araruna Alexandre Augusto Ramalho, Faresin Sonia Maria, Santoro Ilka Lopes
Respiratory Division, Universidade Federal de São Paulo/Escola Paulista de Medicina , São Paulo-SP , Brasil.
J Asthma. 2014 May;51(4):405-10. doi: 10.3109/02770903.2013.878845. Epub 2014 Jan 24.
The goal of this study is to determine whether bronchodilator (BD) response can be used as a reliable measure of asthma control by analyzing the effects of a short course of oral corticosteroids (OC) or placebo (P) on spirometry, sputum cytology and BD response in controlled asthma patients scoring less than 1.5 on the ACQ5.
Seventy patients with moderate to severe asthma who were undergoing combination therapy and were considered to be controlled based on ACQ5 scores, but who exhibited persistent positive BD response, were randomly assigned to two groups, one receiving OC and the other P. Patients were evaluated before and after 2 weeks of treatment. Intervention response (comparison of FEV(1) before and after OC or P treatment) was used as a measure of intervention efficacy, with values equal to or greater than 200 mL considered positive.
Patients who received OC showed significant improvement in FEV(1), and no longer exhibited a positive BD response. Those in the P group showed no change. In addition, sputum eosinophil counts significantly decreased in the OC group.
BD response can be used as a reliable measure of asthma control. This study suggests that ACQ5 scores alone are not sufficient to fully assess asthma control, and that BD response should be included as an essential measurement in any algorithm of asthma control evaluation.
本研究的目的是通过分析短期口服皮质类固醇（OC）或安慰剂（P）对哮喘控制良好且ACQ5评分低于1.5的患者的肺功能、痰液细胞学和支气管扩张剂（BD）反应的影响，来确定BD反应是否可作为哮喘控制的可靠指标。
70例接受联合治疗且根据ACQ5评分被认为病情得到控制，但BD反应持续呈阳性的中重度哮喘患者被随机分为两组，一组接受OC治疗，另一组接受P治疗。在治疗2周前后对患者进行评估。干预反应（OC或P治疗前后FEV(1)的比较）用作干预疗效的指标，数值等于或大于200 mL被视为阳性。
接受OC治疗的患者FEV(1)有显著改善，且不再表现出BD反应阳性。P组患者无变化。此外，OC组痰液嗜酸性粒细胞计数显著下降。
BD反应可作为哮喘控制的可靠指标。本研究表明，仅ACQ5评分不足以全面评估哮喘控制情况，在任何哮喘控制评估算法中，BD反应都应作为一项重要指标纳入。
