Svedmyr N, Löfdahl C G
Division of Clinical Pharmacology, Sahlgrenska University Hospital, Göteborg, Sweden.
Pharmacol Toxicol. 1996 Jan;78(1):3-11. doi: 10.1111/j.1600-0773.1996.tb00172.x.
All guidelines recommend short-acting inhaled beta 2-adrenoceptor agonists as the first-line drugs in acute asthma attacks and inhaled corticosteroids as the drugs of choice when regular daily treatment is needed. Short-acting inhaled beta 2-adrenoceptor agonists are not effective in reducing nocturnal awakenings because of their short duration of action. In addition there has been an intense debate about the regular use of these drugs. This debate is reviewed. They should only be used on "as needed basis". The Swedish guidelines for the treatment of asthma were the first to recommend the new long-acting inhaled beta 2-adrenoceptor agonists at relatively early stage of the illness (800 micrograms daily of inhaled corticosteroids). Two recently completed large multicentre studies with salmeterol in asthmatics support this opinion. Both studies showed a better asthma control with a combination of a low inhaled steroid dose and salmeterol compared to a doubling of the steroid dose. In most asthmatic patients, still symptomatic on inhaled steroids doses 400 to 800 micrograms daily, a test of the addition of inhaled salmeterol is recommended. The steroid dose can be kept low and safe. However, asthmatic patients with either frequent or severe exacerbations should primarily have their steroid dose increased.
所有指南均推荐短效吸入型β2肾上腺素能受体激动剂作为急性哮喘发作的一线用药，而吸入性糖皮质激素则作为需要进行日常规律治疗时的首选药物。短效吸入型β2肾上腺素能受体激动剂因其作用持续时间短，在减少夜间觉醒方面效果不佳。此外，对于这些药物的常规使用一直存在激烈的争论。本文对这一争论进行了综述。它们仅应在“按需使用”的基础上使用。瑞典哮喘治疗指南率先在疾病相对早期（每日吸入800微克糖皮质激素）推荐使用新型长效吸入型β2肾上腺素能受体激动剂。最近两项针对哮喘患者使用沙美特罗完成的大型多中心研究支持了这一观点。两项研究均表明，与将糖皮质激素剂量加倍相比，低剂量吸入糖皮质激素与沙美特罗联合使用能更好地控制哮喘。对于大多数每日吸入400至800微克糖皮质激素仍有症状的哮喘患者，建议试验性加用吸入沙美特罗。这样可以保持糖皮质激素剂量低且安全。然而，频繁发作或严重加重的哮喘患者应首先增加其糖皮质激素剂量。
