Wang Ke, Tian Panwen, Fan Yu, Wang Ye, Liu Chuntao
Department of Respiratory Medicine, West China Hospital, Sichuan University Chengdu 610041, Sichuan Province, P.R. China.
Department of Radiotherapy, Sichuan Cancer Hospital Chengdu 610041, Sichuan Province, P.R. China.
Int J Clin Exp Med. 2015 Oct 15;8(10):19476-80. eCollection 2015.
To evaluate the best second-line treatments for patients with uncontrolled moderate asthma.
A single-center, random study was conducted in adult patients with uncontrolled moderate asthma to evaluate the effects of add-on treatments. After add-on treatments for 4 and 12 weeks, the concentration of exhaled nitric oxide (FeNO), average daily durnal peak expiratory flow (PEF) variability and asthma control test (ACT) score were measured.
94 patients have been divided into three groups to take different add-on treatments, in tiotropium bromide group, montelukast sodium group and double-dose inhaled corticosteroid (ICS) group. After four weeks, most patients improved their symptoms and ACT scores, with lower concentration of FeNO and small PEF variability. In double-dose ICS group, almost all patients took the complete controls of asthma, compared to those in other two groups. After additional 12 weeks' therapy, patients in all three groups nearly achieved complete controls of asthma. There were two patients with pneumonia in double-dose ICS group. Patients in double-dose ICS group had higher ACT scores, lower concentrations of FeNO and smaller PEF variabilities, but a higher risk of pneumonia, compared to those in other two groups. The differences of PEF variabilities and ACT scores between tiotropium group and double-dose ICS group were not significant.
Tiotropium in combination with ICS plus LABA showed the similar effects with double-dose ICS plus LABA, without adverse effects, which might be the best option for optimal control of asthma.
评估未得到控制的中度哮喘患者的最佳二线治疗方案。
在未得到控制的中度哮喘成年患者中开展了一项单中心随机研究，以评估附加治疗的效果。附加治疗4周和12周后，测量呼出一氧化氮（FeNO）浓度、日间平均每日呼气峰值流速（PEF）变异性和哮喘控制测试（ACT）评分。
94例患者被分为三组接受不同的附加治疗，分别为噻托溴铵组、孟鲁司特钠组和双倍剂量吸入性糖皮质激素（ICS）组。4周后，大多数患者症状改善，ACT评分提高，FeNO浓度降低，PEF变异性减小。与其他两组相比，双倍剂量ICS组几乎所有患者的哮喘都得到了完全控制。额外治疗12周后，三组患者几乎都实现了哮喘的完全控制。双倍剂量ICS组有2例患者发生肺炎。与其他两组相比，双倍剂量ICS组患者的ACT评分更高，FeNO浓度更低，PEF变异性更小，但肺炎风险更高。噻托溴铵组和双倍剂量ICS组之间的PEF变异性和ACT评分差异不显著。
噻托溴铵联合ICS加LABA与双倍剂量ICS加LABA效果相似，且无不良反应，可能是实现哮喘最佳控制的最佳选择。
