Malo J L, Cartier A, Côté J, Milot J, Leblanc C, Paquette L, Ghezzo H, Boulet L P
Department of Chest Medicine, Hôpital du Sacré-Coéur, Montreal Canada.
Am J Respir Crit Care Med. 1996 Mar;153(3):953-60. doi: 10.1164/ajrccm.153.3.8630579.
Occupational asthma (OA) is a useful model for the study of asthma in humans. The possibility that inhaled corticosteroids, in addition to withdrawal from the workplace, could improve clinical and functional recovery from OA can be hypothesized. We assessed clinical, functional, and behavioral characteristics of 32 subjects (22 male, 10 female), in all but one of whom OA was confirmed by specific inhalation challenges induced by either high- (n=13) or low-molecular-weight (n=19) agents within 3 mo after cessation of exposure. In this randomized, crossover, double-blind study, subjects (paired for baseline PC20 and duration of symptoms after exposure) received either placebo or 1,000 micrograms of inhaled beclomethasone daily for 1 yr, followed by the alternate medication for 6 mo. Various clinical, functional, and behavioral parameters were examined at each 3-mo visit. Significant improvement in clinical (nocturnal symptoms, cough), functional (morning and evening peak expiratory flow rates), and behavioral (quality of life) parameters were detected in the active-treatment period, although the magnitude of the improvement was relatively small. Side effects (oropharyngeal, reduced cortisol) were similar in the placebo and treatment groups. Distinguishing subjects who started with the active preparation from those who were given placebo first showed that most clinical and behavioral parameters improved in the former instance, whereas there was no significant difference in the latter. We conclude that inhaled corticosteroids induce a small but significant overall improvement of the asthmatic condition in subjects with occupational asthma caused by high- and low-molecular-weight agents after withdrawal from exposure. The beneficial effect is, however, more pronounced if inhaled steroids are given early after diagnosis.
职业性哮喘（OA）是研究人类哮喘的一个有用模型。可以推测，除了脱离工作场所外，吸入性糖皮质激素可能会改善职业性哮喘的临床和功能恢复情况。我们评估了32名受试者（22名男性，10名女性）的临床、功能和行为特征，除1名受试者外，其余所有受试者均在接触停止后3个月内通过高（n = 13）或低分子量（n = 19）物质诱发的特异性吸入激发试验确诊为职业性哮喘。在这项随机、交叉、双盲研究中，受试者（根据基线PC20和接触后症状持续时间配对）接受安慰剂或每日1000微克吸入倍氯米松治疗1年，随后交替使用另一种药物治疗6个月。在每次3个月的随访中检查各种临床、功能和行为参数。在积极治疗期，临床（夜间症状、咳嗽）、功能（早晚呼气峰值流速）和行为（生活质量）参数有显著改善，尽管改善幅度相对较小。安慰剂组和治疗组的副作用（口咽、皮质醇降低）相似。区分开始使用活性制剂的受试者和首先给予安慰剂的受试者发现，在前一种情况下大多数临床和行为参数有所改善，而在后一种情况下没有显著差异。我们得出结论，对于因高、低分子量物质引起的职业性哮喘患者，在脱离接触后，吸入性糖皮质激素可使哮喘病情有小幅但显著的总体改善。然而，如果在诊断后早期给予吸入性类固醇，其有益效果会更明显。
