Dykewicz M S, Greenberger P A, Patterson R, Halwig J M
Arch Intern Med. 1986 Dec;146(12):2369-72.
To study the natural history of corticosteroid-dependent asthma, we evaluated 40 randomly selected adult patients with severe asthma who were refractory to management with inhaled corticosteroids and bronchodilators and who required long-term prednisone therapy (mean duration, 6.2 +/- 5.1 years). During long-term observation, 13 patients (32.5%) significantly improved; ten (25%) of these tolerated discontinuation of long-term prednisone use and three (7.5%) had decreased prednisone requirements. Three patients (7.5%) had increased requirements for prednisone. Twenty-four patients (60%) had generally unchanged, long-term prednisone requirements; of note, eight of these had significant, but temporary intervals (mean, 3.2 years) when they could be managed without prednisone. Patients with mixed asthma were more likely to tolerate discontinuation of long-term prednisone; no other factors studied were predictive of the course of asthma. Although prior to our care many patients had a history of numerous emergency room visits and hospitalizations (some for life-threatening episodes of status asthmaticus), there were few emergency room visits and hospitalizations while under strict management by our service. Variations observed in the natural history of corticosteroid requirements in asthma must be considered in designing studies seeking to evaluate efficacy of new experimental therapies for asthma.
为研究糖皮质激素依赖型哮喘的自然病程，我们评估了40例随机选取的成年重症哮喘患者，这些患者对吸入糖皮质激素和支气管扩张剂治疗无效，需要长期使用泼尼松治疗（平均疗程6.2±5.1年）。在长期观察期间，13例患者（32.5%）显著改善；其中10例（25%）能够耐受停用长期泼尼松治疗，3例（7.5%）泼尼松需求量减少。3例患者（7.5%）泼尼松需求量增加。24例患者（60%）长期泼尼松需求量总体未变；值得注意的是，其中8例有显著但短暂的间隔期（平均3.2年），在此期间无需使用泼尼松即可控制病情。混合型哮喘患者更有可能耐受停用长期泼尼松治疗；所研究的其他因素均不能预测哮喘病程。尽管在我们治疗之前，许多患者有多次急诊就诊和住院史（有些是因危及生命的哮喘持续状态发作），但在我们科室的严格管理下，急诊就诊和住院情况很少。在设计旨在评估哮喘新实验性疗法疗效的研究时，必须考虑哮喘患者糖皮质激素需求量自然病程中观察到的变化。
