Fanelli A, Maggi E, Stendardi L, Gorini M, Duranti R, Scano G
Istituto di Clinica Medica III, Università degli Studi, Florence, Italy.
Chest. 1993 Jan;103(1):122-8. doi: 10.1378/chest.103.1.122.
Bronchial mucosa inflammation is a hallmark of asthma. Epithelial damage due to inflammatory process may contribute to induce a pattern of rapid and shallow breathing (RSB). Probably due to its effects on inflammatory process, beclomethasone dipropionate (BDP) decreases bronchial hypersensitivity (BH), as assessed in terms of histamine concentration causing a 20 percent FEV1 decrease from saline solution (PC20FEV1); however, no data are available on the effect of BDP on RSB. We studied 32 asymptomatic asthmatic subjects with a severe to moderate levels of BH (PC20FEV1 0.01 to 1.7 mg/ml). After they were randomly assigned to one month of either BDP (2 mg daily, 17 patients) or placebo (15 patients), they inhaled progressively doubling concentrations of histamine phosphate by tidal breathing method. With histamine in seven BDP-treated and in five placebo-treated patients, decrease in FEV1 > or = 20 percent from saline solution was paralleled by a significant decrease in tidal volume (VT), inspiratory time (Ti), and expiratory time (Te), and increase in respiratory frequency (RF). In the remaining patients, histamine failed to change the breathing pattern. In the seven RSB patients, BDP resulted in a smaller VT decrease (p < 0.02) and a smaller RF increase (p < 0.02) with histamine. The five RSB placebo-treated patients were then given one month BDP (2 mg daily): inhaled BDP, but not placebo, resulted both in a significant increase in PC20FEV1 and modulation in histamine-induced changes in breathing pattern. We conclude that high doses of BDP seem to be able to modulate histamine-induced RSB, an effect that might be linked to reversal of airway inflammation.
支气管黏膜炎症是哮喘的一个标志。炎症过程导致的上皮损伤可能促使出现快速浅呼吸（RSB）模式。丙酸倍氯米松（BDP）可能因其对炎症过程的作用而降低支气管高敏性（BH），这是根据导致FEV1较生理盐水降低20%时的组胺浓度（PC20FEV1）来评估的；然而，关于BDP对RSB影响的数据尚不可得。我们研究了32名无症状的哮喘患者，其BH程度为中重度（PC20FEV1为0.01至1.7毫克/毫升）。在将他们随机分为接受一个月BDP治疗组（每日2毫克，17例患者）或安慰剂组（15例患者）后，他们通过潮气呼吸法吸入浓度逐渐加倍的磷酸组胺。在7名接受BDP治疗的患者和5名接受安慰剂治疗的患者中，当FEV1较生理盐水降低≥20%时，潮气量（VT）、吸气时间（Ti）和呼气时间（Te）显著降低，呼吸频率（RF）增加。在其余患者中，组胺未能改变呼吸模式。在7名出现RSB的患者中，BDP使组胺引起的VT降低幅度较小（p<0.02），RF增加幅度较小（p<0.02）。然后给5名接受安慰剂治疗的RSB患者一个月的BDP（每日2毫克）治疗：吸入BDP而非安慰剂，导致PC20FEV1显著增加，并调节了组胺诱导的呼吸模式变化。我们得出结论，高剂量的BDP似乎能够调节组胺诱导的RSB，这一效应可能与气道炎症的逆转有关。
