吸入性糖皮质激素对日本运动员支气管哮喘的影响。

Effect of inhaled corticosteroids on bronchial asthma in Japanese athletes.

作者信息

Hoshino Yoshifumi, Koya Toshiyuki, Kagamu Hiroshi, Tsukioka Keisuke, Toyama Mio, Sakagami Takuro, Hasegawa Takashi, Narita Ichiei, Arakawa Masaaki, Suzuki Eiichi

机构信息

Division of Respiratory Medicine, Department of Homeostatic Regulation and Development, Course in Biological Functions and Medical Control, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

出版信息

Allergol Int. 2015 Apr;64(2):145-9. doi: 10.1016/j.alit.2014.10.004. Epub 2014 Nov 21.

DOI:10.1016/j.alit.2014.10.004

PMID:25838089

Abstract

BACKGROUND

Asthma has a higher prevalence in athlete populations such as Olympic athletes than in the general population. Correct diagnosis and management of asthma in athletes is important for symptom control and avoidance of doping accusations. However, few reports are available on asthma treatment in the athlete population in clinical practice. In this study, we focused on the clinical efficacy of inhaled corticosteroid (ICS) for asthma in a Japanese athlete population.

METHODS

The study subjects included athletes who visited the Niigata Institute for Health and Sports Medicine, Niigata, Japan for athletic tests and who were diagnosed with asthma on the basis of respiratory symptoms and positive results in a bronchodilator or bronchial provocation test such as exercise, hypertonic saline, or methacholine provocation. The athletes received ICS alone for at least 3 months, and the clinical background, sports type, and treatment efficacy were analyzed.

RESULTS

The study population comprised 80 athletes (59 men and 21 women) with a median age of 16.0 years. Regarding sports type, 28 athletes engaged in winter sports (35%), 22 in endurance sports (27.5%), and 25 in indoor sports (31.3%). Although ICS is the primary treatment in athlete asthma, 16.3% of the athletes showed an unsatisfactory response to treatment according to the Global Evaluation of Treatment Effectiveness (GETE). These subjects were characterized by a decreased response to methacholine and lower values for FEV1/FVC and type 2 helper T cell (Th2)-associated biomarkers relative to responsive athletes. In multivariate analysis, FEV1/FVC and the logarithm to the base 10 of the IgE level were independently associated with the ICS response.

CONCLUSIONS

These data suggest that ICS is effective for asthma in most athletes. However, certain asthmatic athletes are less responsive to ICS than expected. The pathogenesis in these subjects may differ from that of conventional asthma characterized by chronic allergic airway inflammation.

摘要

背景

哮喘在运动员群体（如奥运会运动员）中的患病率高于普通人群。正确诊断和管理运动员的哮喘对于症状控制和避免兴奋剂指控至关重要。然而，临床实践中关于运动员群体哮喘治疗的报道较少。在本研究中，我们聚焦于吸入性糖皮质激素（ICS）对日本运动员群体哮喘的临床疗效。

方法

研究对象包括前往日本新潟健康与运动医学研究所进行运动测试且根据呼吸道症状以及支气管扩张剂或支气管激发试验（如运动、高渗盐水或乙酰甲胆碱激发试验）呈阳性结果而被诊断为哮喘的运动员。这些运动员单独接受ICS治疗至少3个月，并对临床背景、运动类型和治疗效果进行分析。

结果

研究人群包括80名运动员（59名男性和21名女性），中位年龄为16.0岁。关于运动类型，28名运动员从事冬季运动（35%），22名从事耐力运动（27.5%），25名从事室内运动（31.3%）。尽管ICS是运动员哮喘的主要治疗方法，但根据全球治疗效果评估（GETE），16.3%的运动员对治疗反应不佳。相对于有反应的运动员，这些受试者的特征是对乙酰甲胆碱反应降低，FEV1/FVC值和2型辅助性T细胞（Th2）相关生物标志物较低。在多变量分析中，FEV1/FVC和IgE水平以10为底的对数与ICS反应独立相关。