Even P, Caubarrère I, Sors H, Bonan G, Stern M, Salem A, Le Gros V, Renom D
Service de Pneumologie, Hôpital Laennec, Paris.
Presse Med. 1989 Jun 17;18(24):1191-4.
Two therapeutic trials aimed at determining whether a high-dose inhaled corticosteroid, beclomethasone dipropionate (BDP), could reduce or suppress a long term and continuous treatment with a systemic corticosteroid, triamcinolone acetonide (TA), were carried out in a homogeneous population of severe, steroid-dependent asthmatics. The first one was a controlled, double-blind versus placebo trial involving 25 patients followed up for 5 months. The second one was an open trial involving 105 patients followed up for 12 months. In both trials the mean doses of TA were reduced by 60 to 65 per cent, and TA could be totally or nearly totally suppressed in almost 60 per cent of the cases with clinical and functional results that were equal or superior to those previously obtained with systemic corticosteroid therapy. It is concluded that: (a) continuous systemic corticosteroid therapy in mean doses of more than 5 mg/day of prednisone equivalent is now rarely indicated in patients with steroid-dependent asthma, and (b) inhaled corticosteroid therapy with BDP could be extended to cases of non steroid-dependent asthma inadequately controlled by bronchodilators.
针对严重的、依赖类固醇的哮喘患者这一同质群体，开展了两项治疗试验，旨在确定高剂量吸入性皮质类固醇丙酸倍氯米松（BDP）是否能够减少或抑制全身性皮质类固醇曲安奈德（TA）的长期持续治疗。第一项试验是一项对照、双盲、与安慰剂对比的试验，涉及25名患者，随访5个月。第二项试验是一项开放性试验，涉及105名患者，随访12个月。在两项试验中，TA的平均剂量均降低了60%至65%，并且在近60%的病例中TA能够被完全或几乎完全抑制，临床和功能结果等同于或优于先前全身性皮质类固醇治疗所获得的结果。得出以下结论：（a）对于依赖类固醇的哮喘患者，目前很少需要使用平均剂量超过5mg/天泼尼松等效剂量的持续全身性皮质类固醇治疗；（b）使用BDP的吸入性皮质类固醇治疗可扩展至使用支气管扩张剂控制不佳的非依赖类固醇哮喘病例。
