Bianco S, Pieroni M G, Refini R M, Robuschi M, Vaghi A, Sestini P
Institute of Respiratory and Cardiovascular Diseases, Ospedale S. Raffaele, Milan, Italy.
Eur Respir J. 1993 Jan;6(1):130-4.
The observation that changes in bronchial osmolarity can induce bronchoconstriction in asthma inspired the experimental studies which, unexpectedly, revealed that frusemide is an effective bronchoprotective agent against a variety of osmotic and non osmotic stimuli. Although the mechanism of this protective effect is not fully understood, studies in vivo and in vitro suggest that frusemide may inhibit the activation of different cell types induced by bronchoconstrictor stimuli. Other loop diuretics also exert bronchoprotective activity, but frusemide appears to be the more effective bronchoprotective agent of this family, regardless of their diuretic potency and lipid solubility. Despite the relatively large amount of experimental evidence, there is currently little information on the clinical effectiveness of frusemide in asthma and a long-term controlled study is currently in progress. The observations that treatment with a combination of inhaled acetylsalicylate and frusemide results in a markedly increased bronchoprotective effect compared to either drug alone, opens a new perspective in the possible clinical use of these drugs. Preliminary studies suggest that the association of these drugs is well tolerated and may result in a remarkable steroid sparing effect in patients with steroid dependent asthma, for whom a convenient alternative to long-term steroid therapy is not currently available.
支气管渗透压变化可诱发哮喘患者支气管收缩这一观察结果激发了实验研究，而这些研究意外地发现，速尿是一种有效的支气管保护剂，可抵御多种渗透和非渗透刺激。尽管这种保护作用的机制尚未完全明确，但体内和体外研究表明，速尿可能会抑制支气管收缩刺激所诱导的不同细胞类型的激活。其他袢利尿剂也具有支气管保护活性，但无论其利尿效力和脂溶性如何，速尿似乎是该类药物中更有效的支气管保护剂。尽管有相对大量的实验证据，但目前关于速尿在哮喘中的临床疗效的信息很少，一项长期对照研究正在进行中。吸入乙酰水杨酸酯和速尿联合治疗比单独使用任何一种药物都能显著增强支气管保护作用，这一观察结果为这些药物的临床应用开辟了新的前景。初步研究表明这些药物联合使用耐受性良好，对于依赖类固醇的哮喘患者可能会产生显著的类固醇节省效应，目前尚无方便的替代长期类固醇治疗的方法。
