Carmichael J, Paterson I C, Diaz P, Crompton G K, Kay A B, Grant I W
Br Med J (Clin Res Ed). 1981 May 2;282(6274):1419-22. doi: 10.1136/bmj.282.6274.1419.
Fifty-eight patients with chronic asthma in whom airflow obstruction was relieved by bronchodilator aerosols but not by oral corticosteroids were compared with 58 other chronic asthmatics who responded equally well to both treatments. The two groups were matched for age and sex. The only significant clinical differences between the two groups were that in the "corticosteroid-resistant" patients there was a more frequent family history of asthma and a longer duration of symptoms. Resistant patients also had a relatively lower peak expiratory flow rate in the morning than later in the day and a greater degree of bronchial reactivity to methacholine. Such features, however, may not be specific criteria of corticosteroid resistance since they were also observed in untreated asthmatics who subsequently responded well to corticosteroids. The failure of prednisolone to inhibit a monocyte-mediated bronchial reaction may explain why some chronic asthmatics do not respond to corticosteroids. Patients with corticosteroid-resistant asthma should be recognised at an early stage so that regular treatment with oral corticosteroids may be withdrawn. Failure to do this results in needless exposure to the risk of developing serious side effects.
将58例慢性哮喘患者与另外58例慢性哮喘患者进行比较，前一组患者使用支气管扩张气雾剂可缓解气流阻塞，但使用口服皮质类固醇无效，而后一组患者对两种治疗的反应均良好。两组在年龄和性别上相匹配。两组之间唯一显著的临床差异在于，“皮质类固醇抵抗”患者的哮喘家族史更常见，症状持续时间更长。抵抗患者清晨的呼气峰值流速也相对低于当天晚些时候，且对乙酰甲胆碱的支气管反应性更强。然而，这些特征可能并非皮质类固醇抵抗的特异性标准，因为在随后对皮质类固醇反应良好的未经治疗的哮喘患者中也观察到了这些特征。泼尼松龙未能抑制单核细胞介导的支气管反应，这或许可以解释为何一些慢性哮喘患者对皮质类固醇无反应。皮质类固醇抵抗性哮喘患者应尽早被识别出来，以便能够停用口服皮质类固醇的常规治疗。若不这样做，会导致患者不必要地面临出现严重副作用的风险。
