Fukuoka J
First Department of Internal Medicine, Osaka Medical College, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1994 Aug;32(8):731-8.
Clinical experiences have suggested distinct differences in responses to anti-asthmatic drugs between patients suffering early morning asthmatic attacks and those experiencing nocturnal ones. However, there has been no report on any difference in the improvement of asthmatic flow dipping after inhaled and/or oral steroid treatment. In this retrospective study, the peak expiratory flow rates (PEF), which had been monitored four times a day, were reviewed in 40 chronic asthmatics. The group consisted of 19 patients with very low PEF (geometrical mean PEF/week [mPEF] < 60% of the personal best PEF), 15 patients with moderately low PEF (mPEF 60% to 70% of personal best PEF), 2 patients with mildly low PEF (mPEF 70% to 80% of personal best PEF) and 4 patients with occasionally low PEF (mPEF > 80% of personal best PEF). Of 40 chronic asthmatics, 22 patients had morning dipping alone and 10 patients had both morning dipping and nocturnal dipping. After inhaled and/or oral steroid treatment at sufficient level, mPEF was improved in all patients. All the dipping disappeared except for morning dipping in five cases. We concluded that there was a difference in responses to inhaled and/or oral steroids during early morning dipping and during nocturnal dipping in chronic asthmatics. There should be further investigation to discriminate between pathophysiological events that may be related to morning dipping and to nocturnal dipping.
临床经验表明，清晨哮喘发作的患者与夜间哮喘发作的患者对抗哮喘药物的反应存在明显差异。然而，关于吸入和/或口服类固醇治疗后哮喘气流下降改善情况的差异尚无报告。在这项回顾性研究中，对40例慢性哮喘患者每天监测4次的呼气峰值流速（PEF）进行了回顾。该组包括19例PEF极低的患者（几何平均PEF/周[mPEF]<个人最佳PEF的60%），15例PEF中度低的患者（mPEF为个人最佳PEF的60%至70%），2例PEF轻度低的患者（mPEF为个人最佳PEF的70%至80%）和4例偶尔PEF低的患者（mPEF>个人最佳PEF的80%）。40例慢性哮喘患者中，22例仅有清晨气流下降，10例既有清晨气流下降又有夜间气流下降。在进行足够剂量的吸入和/或口服类固醇治疗后，所有患者的mPEF均有改善。除5例患者仍有清晨气流下降外，所有气流下降均消失。我们得出结论，慢性哮喘患者在清晨气流下降和夜间气流下降期间对吸入和/或口服类固醇的反应存在差异。应进一步研究以区分可能与清晨气流下降和夜间气流下降相关的病理生理事件。
