Levy M L, Stevenson C, Maslen T
Prestwood Avenue Surgery, Kenton, Harrow, UK.
Thorax. 1996 Nov;51(11):1087-92. doi: 10.1136/thx.51.11.1087.
Oral corticosteroids used in short courses for acute asthma are regarded as safe, although the frequent use of these drugs may result in patients suffering from systemic side effects. It has become common practice for patients to increase their own inhaled corticosteroid intake when their asthma goes out of control, but it has never been established whether a high dose of inhaled corticosteroid can be as effective as a short course of oral corticosteroid in the treatment of acute exacerbations.
A multicentre, randomised, double blind, double dummy, parallel group study was undertaken to determine whether the introduction of a high dose of inhaled fluticasone propionate (2 mg daily) is as effective as a short reducing course of oral prednisolone (starting at 40 mg/day and reducing by 5 mg every other day) in the treatment of acute exacerbations of asthma not considered severe enough for admission to hospital but requiring treatment with oral corticosteroid.
Four hundred and thirteen adult asthmatic subjects who presented to their general practitioner with an acute exacerbation of asthma were recruited in 47 general practices in the United Kingdom. Treatment failures, defined as a reduction in peak expiratory flow (PEF) to below 60% of the patient's best/predicted value on two consecutive occasions or persistent symptoms with no improvement on three consecutive days, occurred in 23% of patients who received oral prednisolone and 27% who received inhaled fluticasone propionate (difference in percentage of treatment failures 4.3, 95% CI -4.1 to 12.8, p = 0.31). In each group 48% were classified as treatment successes, defined as a 10% or greater increase in percentage best/predicted morning PEF. Both treatments were equally well tolerated.
There is no evidence of a significant difference in efficacy between a reducing dose course of oral prednisolone and high dose inhaled fluticasone propionate in mild exacerbations of asthma which do not require admission to hospital.
用于急性哮喘短期治疗的口服皮质类固醇被认为是安全的，尽管频繁使用这些药物可能会导致患者出现全身性副作用。当哮喘失控时，患者自行增加吸入性皮质类固醇的摄入量已成为常见做法，但高剂量吸入性皮质类固醇在治疗急性加重期时是否能与短期口服皮质类固醇一样有效，尚无定论。
开展了一项多中心、随机、双盲、双模拟、平行组研究，以确定引入高剂量丙酸氟替卡松（每日2毫克）在治疗哮喘急性加重期时是否与短期递减疗程的口服泼尼松龙（起始剂量为40毫克/天，每隔一天减少5毫克）一样有效，这些急性加重期虽不足以严重到需住院治疗，但需要口服皮质类固醇治疗。
在英国47家普通诊所招募了413名因哮喘急性加重而就诊于全科医生的成年哮喘患者。治疗失败定义为连续两次呼气峰值流速（PEF）降至患者最佳/预测值的60%以下，或连续三天症状持续且无改善。接受口服泼尼松龙的患者中23%出现治疗失败，接受吸入丙酸氟替卡松的患者中27%出现治疗失败（治疗失败百分比差异为4.3，95%置信区间为-4.1至12.8，p = 0.31）。每组中48%被归类为治疗成功，定义为最佳/预测的早晨PEF百分比增加10%或更多。两种治疗的耐受性相同。
对于不需要住院治疗的轻度哮喘加重期，口服泼尼松龙递减剂量疗程与高剂量吸入丙酸氟替卡松在疗效上没有显著差异的证据。
