Toogood J H, Baskerville J, Jennings B, Lefcoe N M, Johansson S A
Am Rev Respir Dis. 1984 May;129(5):723-9. doi: 10.1164/arrd.1984.129.5.723.
Budesonide, a topically active corticosteroid, was administered in doses of 400 and 1,600 micrograms/day to 35 asthmatic adults, using a standard inhalation device or a tube or cone spacer. The spacers reduced oropharyngeal candidiasis by an amount equivalent to a 90% reduction in drug dose (p = less than 0.005) and doubled the drug's overall antiasthmatic potency (delta FEV1, p = 0.05) without significantly increasing its overall effect on blood eosinophils (p = 0.14) or the A.M. serum cortisol (p = 0.12). Steroid-induced neutrophilia increased by an amount approximating that produced by an extra half tablet of prednisone per day (p = 0.002). Both the airways and systemic effects of the spacers were greater in patients who had small airways dysfunction present prior to the study. The data suggest an increase in intrapulmonary drug deposition during spacer treatment without a material shift in regional delivery within the lung. Spacers should be particularly useful for patients whose response to inhaled steroid is compromised by by dose-limiting oropharyngeal complications. They can also reduce drug costs. They should be used selectively in children until their effect on regional intrapulmonary drug deposition has been more clearly defined.
布地奈德是一种具有局部活性的皮质类固醇，使用标准吸入装置或管形或锥形储雾罐，以每日400微克和1600微克的剂量给予35名成年哮喘患者。储雾罐可使口咽念珠菌病减少，减少量相当于药物剂量减少90%（p<0.005），并使药物的总体抗哮喘效力提高一倍（FEV1变化，p = 0.05），而对血液嗜酸性粒细胞的总体影响（p = 0.14）或上午血清皮质醇（p = 0.12）无显著增加。类固醇诱导的中性粒细胞增多的增加量近似于每天额外服用半片泼尼松所产生的增加量（p = 0.002）。在研究前存在小气道功能障碍的患者中，储雾罐对气道和全身的影响更大。数据表明，在储雾罐治疗期间肺内药物沉积增加，而肺内区域递送无实质性变化。储雾罐对于因剂量限制性口咽并发症而影响吸入类固醇反应的患者应特别有用。它们还可降低药物成本。在对其对肺内区域药物沉积的影响更明确之前，应在儿童中选择性使用。
