Green S S, Lamb G C, Schmitt S, Kaufman J
Medical College of Wisconsin, Milwaukee.
J Allergy Clin Immunol. 1995 Jan;95(1 Pt 1):15-22. doi: 10.1016/s0091-6749(95)70147-8.
Tapering regimens of oral steroids may be difficult or confusing for some patients. Repository steroids have been shown to be as effective as tapering oral doses in preventing relapse after emergency treatment. This study was undertaken to determine whether repository steroids are as effective as tapering oral steroids in preventing relapse after hospitalization for treatment of asthma. Twenty-six patients with acute exacerbations of asthma requiring treatment for 24 to 72 hours with parenteral steroids were randomized into two groups. Both groups received oral prednisone, 60 mg daily, when parenteral steroids were discontinued. At discharge, one group received intramuscular placebo and oral prednisone tapered over 8 days, and the other received 80 mg intramuscular methylprednisolone sodium acetate and oral placebo. At discharge and 2-week follow-up, patients were interviewed and examined, and spirometry results were obtained. There was little difference between groups in ratings of symptoms at discharge or follow-up. Both groups had less wheezing at follow-up than at discharge, though the improvement was significant only in the repository steroid group (p < 0.05). Mean forced expiratory volume in 1 second, forced vital capacity, peak expiratory flow rate improved at follow-up in both groups. No significant differences in outcome were found between the oral and repository steroid groups.
对于一些患者来说，口服类固醇的减量方案可能会很困难或令人困惑。长效类固醇已被证明在紧急治疗后预防复发方面与逐渐减少口服剂量一样有效。本研究旨在确定长效类固醇在哮喘住院治疗后预防复发方面是否与逐渐减少口服类固醇一样有效。26例因急性哮喘加重需要接受24至72小时胃肠外类固醇治疗的患者被随机分为两组。两组在停用胃肠外类固醇时均接受每日60毫克的口服泼尼松。出院时，一组接受肌肉注射安慰剂和在8天内逐渐减量的口服泼尼松，另一组接受80毫克肌肉注射醋酸甲基泼尼松龙钠和口服安慰剂。在出院时和随访2周时，对患者进行访谈和检查，并获得肺活量测定结果。两组在出院时或随访时的症状评分差异不大。两组在随访时的喘息都比出院时少，尽管只有长效类固醇组的改善具有统计学意义（p<0.05）。两组在随访时1秒用力呼气量、用力肺活量、呼气峰值流速均有所改善。口服和长效类固醇组在结局方面未发现显著差异。
