Meeran K, Burrin J M, Noonan K A, Price C P, Ind P W
Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London, UK.
Postgrad Med J. 1995 Mar;71(833):156-9. doi: 10.1136/pgmj.71.833.156.
Inhaled steroids are increasingly advocated as first line treatment for mild asthma. Some studies suggest that inhaled steroids suppress bone formation as reflected by a fall in plasma osteocalcin. Spacers have been shown to increase the proportion of inhaled aerosol that is deposited in the lungs and to reduce the amount swallowed. We measured plasma osteocalcin levels to determine the effect on bone formation of inhaled beclomethasone dipropionate (BDP) with and without a 750 ml spacer in a double-blind, randomised, placebo-controlled, cross-over study. Twenty-six healthy male volunteers took BDP 500 micrograms (two puffs of Becloforte) together with two puffs of placebo, inhaled twice daily for seven days. One inhaler was taken directly while the other was inhaled through a 750 ml spacer. After a two week washout period, the inhalers were exchanged so that BDP was taken by the alternate route for a further seven days. Fasting plasma osteocalcin levels were measured at 09.00 h before and at the end of each week. After a week of BDP taken directly (without a spacer), osteocalcin levels fell from 11.8 (SEM 0.6) ng/ml to 9.5 (SEM 0.5) ng/ml (p < 0.001). After a week of BDP taken through a spacer, osteocalcin levels fell from 12.1 (SEM 0.5) ng/ml to 11.1 (SEM 0.5) ng/ml (p < 0.001). The fall in osteocalcin when a spacer was used was significantly less than when BDP was taken directly (p < 0.005). This is likely to be because the systemic effects on bone are caused by swallowed rather than inhaled BDP, and this is limited by the use of a spacer. Spacers should be more widely prescribed with inhaled steroids. Further prospective studies are indicated to evaluate whether spacers protect bone mass.
吸入性类固醇越来越多地被提倡作为轻度哮喘的一线治疗药物。一些研究表明，吸入性类固醇会抑制骨形成，这可通过血浆骨钙素水平下降来反映。已证实储雾罐可增加沉积在肺部的吸入气雾剂比例，并减少吞咽量。在一项双盲、随机、安慰剂对照、交叉研究中，我们测量了血浆骨钙素水平，以确定使用和不使用750毫升储雾罐吸入丙酸倍氯米松（BDP）对骨形成的影响。26名健康男性志愿者每天吸入两次BDP 500微克（两喷必可酮）以及两喷安慰剂，持续7天。一次直接使用吸入器，另一次通过750毫升储雾罐吸入。经过两周的洗脱期后，交换吸入器，使BDP通过另一种方式再吸入7天。在每周开始前和结束时的09:00测量空腹血浆骨钙素水平。直接吸入BDP（不使用储雾罐）一周后，骨钙素水平从11.8（标准误0.6）纳克/毫升降至9.5（标准误0.5）纳克/毫升（p<0.001）。通过储雾罐吸入BDP一周后，骨钙素水平从12.1（标准误0.5）纳克/毫升降至11.1（标准误0.5）纳克/毫升（p<0.001）。使用储雾罐时骨钙素的下降明显小于直接吸入BDP时（p<0.005）。这可能是因为对骨骼的全身影响是由吞咽而非吸入的BDP引起的，而储雾罐的使用限制了这种情况。吸入性类固醇应更广泛地与储雾罐一起开处方。需要进一步的前瞻性研究来评估储雾罐是否能保护骨量。
