Kudo K, Hojo M, Kabe J
Department of Pulmonology, International Medical Center of Japan, Tokyo, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1995 Sep;33(9):956-65.
We studied the usefulness of 24 weeks of therapy with inhaled beclomethasone dipropionate (BDP) in the management of mild and moderately severe asthma in adults. To determine the optimal dose and treatment duration, the patients were divided into three groups. Patients in group I (n = 10) were treated with bronchodilators but no BDP. Patients in group II (n = 12) received bronchodilators and 450 micrograms/day of BDP. Patients in group III (n = 17) received bronchodilators and 900 micrograms/day of BDP. BDP was inhaled via a large spacer (Volumatic). Asthma scores were measured before treatment began, and again every 2 weeks for the duration of the study (26 weeks). Peak expiratory flows (PEF) were measured before treatment began, 2 weeks after treatment had begun, and again every four weeks until the end of the study. Vital capacity, FEV1, and bronchial reactivity to methacholine were measured before treatment began, and again 12 weeks and 24 weeks after it had begun. Adrenocortical function in patients in group III was measured with a rapid ACTH test, at the same time as the pulmonary functions were measured. The results were: 1) Asthma scores decreased more in patients who received the higher dose of BDP than in those who received the lower dose, especially during the second 12 weeks. 2) After two weeks of treatment, %PEF had increased significantly in both groups that received BDP, but after six weeks of treatment there was no further improvement. %PEF did not improve in the group given bronchodilators only. 3) In the patients whose baseline %PEF was less than 80%, only the higher dose of BDP significantly increased %PEF. 4) Only the higher dose of BDP increased the %VC, the FEV1%, and the PD20 for methacholine. 5) Asthma type and severity were not related to the usefulness of BDP therapy. 6) Results of the rapid ACTH test indicated that the higher dose of BDP did not suppress adrenocortical function. These data indicate that 900 micrograms of BDP per day is more effective than 450 micrograms/day as initial therapy for long-term management of mild or moderate asthma in adults, and that the dose of BDP should be reviewed after 3 months of treatment. Patients in whom asthma is well-controlled may tolerate a reduction in dose, and those in whom asthma is not well-controlled may require a higher dose.
我们研究了吸入丙酸倍氯米松（BDP）治疗24周对成人轻度和中度严重哮喘的疗效。为确定最佳剂量和治疗时长，将患者分为三组。第一组（n = 10）患者仅接受支气管扩张剂治疗，未使用BDP。第二组（n = 12）患者接受支气管扩张剂治疗并每日吸入450微克BDP。第三组（n = 17）患者接受支气管扩张剂治疗并每日吸入900微克BDP。BDP通过大型储雾罐（Volumatic）吸入。在治疗开始前测量哮喘评分，在研究期间（26周）每2周再次测量。在治疗开始前、治疗开始2周后以及此后每4周直至研究结束测量呼气峰值流速（PEF）。在治疗开始前、治疗开始12周和24周后测量肺活量、第一秒用力呼气容积（FEV1）以及对乙酰甲胆碱的支气管反应性。在测量肺功能的同时，用快速促肾上腺皮质激素试验测量第三组患者的肾上腺皮质功能。结果如下：1）接受高剂量BDP的患者哮喘评分下降幅度大于接受低剂量BDP的患者，尤其是在第二个12周期间。2）治疗两周后，接受BDP治疗的两组患者的%PEF均显著升高，但治疗六周后未进一步改善。仅接受支气管扩张剂治疗的组中%PEF未改善。3）在基线%PEF低于80%的患者中，仅高剂量BDP显著提高了%PEF。4）仅高剂量BDP增加了%肺活量、FEV1%以及对乙酰甲胆碱的PD20。5）哮喘类型和严重程度与BDP治疗的疗效无关。6）快速促肾上腺皮质激素试验结果表明，高剂量BDP未抑制肾上腺皮质功能。这些数据表明，作为成人轻度或中度哮喘长期管理的初始治疗，每日900微克BDP比每日450微克更有效，且治疗3个月后应复查BDP剂量。哮喘得到良好控制的患者可能耐受剂量降低，而哮喘控制不佳的患者可能需要更高剂量。
