Weiner P, Weiner M, Azgad Y, Zamir D
Department of Medicine A, Hillel-Yaffe Medical Center, Hadera, Israel.
Chest. 1995 Dec;108(6):1568-71. doi: 10.1378/chest.108.6.1568.
A significant minority of patients with COPD have favorable response to corticosteroid treatment. In addition, the benefit of corticosteroid treatment may be outweighed by the side effects. Long-term administration of inhaled steroids is a safe means of treatment. We hypothesized that treatment with high-dose inhaled budesonide would improve clinical symptoms and pulmonary function in subjects with COPD, and that the response to inhaled beta 2-agonist will serve to individualize steroid responders. We compared a 6-week course of 800 micrograms/d inhaled budesonide with placebo, separated by 4 weeks when no medication was taken, in a double-blind crossover trial, in 8 patients responding to inhaled beta 2-agonist, and in 22 nonresponders with stable COPD. In six of eight "responders to beta 2-agonist," there was a significant improvement in the FEV1 (defined as > or = 20%) following inhaled budesonide, as compared with placebo. In the 22 "nonresponders to beta 2-agonist," there was no significant improvement in the mean FEV1 (1.41 +/- 0.1 L before, and 1.61 +/- 0.1 L after treatment) with inhaled budesonide or placebo. Over the 6-week course of treatment by either budesonide or placebo, the nonresponders reported similar beta 2-agonist consumption (4.8 +/- 0.2 and 5.0 +/- 0.1 puffs per patient per day, respectively). However, there was a significant difference between the two periods of treatment in the responders as for the mean daily number of beta 2-agonist inhalations (2.4 +/- 0.1 in the budesonide period as compared with 5.3 +/- 0.1 in the placebo period; p < 0.005). We conclude that treatment with inhaled steroids improved spirometry data and inhaled beta 2-agonist consumption in about 25% of patients with stable COPD, and this rate is increased to about 75% in patients who respond to beta 2-agonist inhalation.
相当一部分慢性阻塞性肺疾病（COPD）患者对皮质类固醇治疗反应良好。此外，皮质类固醇治疗的益处可能会被其副作用所抵消。长期吸入类固醇是一种安全的治疗方法。我们假设，高剂量吸入布地奈德治疗可改善COPD患者的临床症状和肺功能，并且对吸入β2激动剂的反应将有助于区分对类固醇有反应者。在一项双盲交叉试验中，我们将8名对吸入β2激动剂有反应的患者和22名病情稳定的无反应COPD患者，分为两组，一组接受为期6周、每日吸入800微克布地奈德的疗程，另一组接受安慰剂治疗，两组治疗间隔4周，期间不服用任何药物。在8名“对β2激动剂有反应者”中，有6名患者吸入布地奈德后，第一秒用力呼气容积（FEV1）（定义为增加≥20%）较安慰剂组有显著改善。在22名“对β2激动剂无反应者”中，吸入布地奈德或安慰剂后，平均FEV1（治疗前为1.41±0.1升，治疗后为1.61±0.1升）无显著改善。在布地奈德或安慰剂治疗的6周疗程中，无反应者报告的β2激动剂使用量相似（分别为每位患者每天4.8±0.2喷和5.0±0.1喷）。然而，在有反应者中，两个治疗期的每日β2激动剂吸入平均次数存在显著差异（布地奈德治疗期为2.4±0.1喷，而安慰剂治疗期为5.3±0.1喷；p<0.005）。我们得出结论，吸入类固醇治疗可改善约25%病情稳定的COPD患者的肺量计数据和β2激动剂吸入量，而在对β2激动剂吸入有反应的患者中，这一比例增加至约75%。
