Weir D C, Burge P S
Chest Research Institute, East Birmingham Hospital.
Thorax. 1993 Apr;48(4):309-16. doi: 10.1136/thx.48.4.309.
The effect of treatment with inhaled corticosteroids in patients with non-asthmatic chronic airflow obstruction is still disputed. Whether any physiological improvements seen are accompanied by changes in bronchial responsiveness and symptoms and quality of life is also still unclear.
A sequential placebo controlled, blinded parallel group study investigating the effect of three weeks of treatment with inhaled beclomethasone dipropionate (BDP), 750 micrograms or 1500 micrograms twice daily, and oral prednisolone, 40 mg per day, was carried out in 105 patients with severe non-asthmatic chronic airflow obstruction (mean age 66 years, mean forced expiratory volume in one second (FEV1) 1.05 litres [40% predicted], geometric mean PD20 0.52 mumol). End points assessed were FEV1, forced vital capacity (FVC), and peak expiratory flow (PEF), bronchial responsiveness to inhaled histamine, and quality of life as measured by a formal quality of life questionnaire.
Both doses of BDP produced equivalent, small, but significant improvements in FEV1 (mean 48 ml), FVC (mean 120 ml), and PEF (mean 12.4 l/min). The addition of oral prednisolone to the treatment regime in two thirds of the patients did not produce any further improvement in these parameters. Inhaled BDP produced a treatment response in individual patients (defined as an improvement in FEV1, FVC, or mean PEF of at least 20% compared with baseline values) more commonly than placebo (34% v 15%). The two doses of BDP were equally effective in this respect and again no further benefit of treatment with oral prednisolone was noted. Treatment with BDP for up to six weeks did not affect bronchial responsiveness to histamine. Small but significant improvements were seen in dyspnoea during daily activities, and the feeling of mastery over the disease.
High dose inhaled BDP is an effective treatment for patients with chronic airflow obstruction not caused by asthma. Both objective and subjective measures show improvement. Unlike asthma, no improvement in bronchial responsiveness was detected after six weeks of treatment.
吸入性糖皮质激素治疗非哮喘性慢性气流受限患者的效果仍存在争议。所观察到的任何生理改善是否伴有支气管反应性、症状及生活质量的变化也尚不清楚。
一项序贯安慰剂对照、双盲平行组研究，对105例重度非哮喘性慢性气流受限患者（平均年龄66岁，一秒用力呼气容积（FEV1）平均为1.05升[预计值的40%]，组胺激发试验的几何平均PD20为0.52 μmol）进行了为期3周的吸入丙酸倍氯米松（BDP）治疗效果的研究，BDP剂量为每日2次，每次750微克或1500微克，同时给予口服泼尼松龙，每日40毫克。评估的终点指标包括FEV1、用力肺活量（FVC）、呼气峰流速（PEF）、对吸入组胺的支气管反应性以及通过正式生活质量问卷测量的生活质量。
两种剂量的BDP均使FEV1（平均增加48毫升）、FVC（平均增加120毫升）和PEF（平均增加12.4升/分钟）出现同等程度的、微小但显著的改善。在三分之二的患者中，治疗方案中加用口服泼尼松龙并未使这些参数进一步改善。与安慰剂相比，吸入BDP在个体患者中产生治疗反应（定义为FEV1、FVC或平均PEF较基线值至少改善20%）更为常见（34%对15%）。在这方面，两种剂量的BDP效果相同，同样未观察到口服泼尼松龙治疗有进一步益处。BDP治疗长达6周未影响对组胺的支气管反应性。日常活动中的呼吸困难及对疾病的掌控感有微小但显著的改善。
高剂量吸入BDP是治疗非哮喘性慢性气流受限患者的有效方法。客观和主观指标均显示有改善。与哮喘不同，治疗6周后未检测到支气管反应性的改善。
