Ikuta N, Kondoh Y, Tangiguchi H, Gotoh K, Yanagisawa K, Suzuki R, Takagi K
Division of Respirology, Tosei General Hospital.
Arerugi. 1996 Dec;45(12):1231-6.
We studied retrospectively the effect of long-term treatment with an inhaled corticosteroid on bronchial hyperresponsiveness (BHR) and clinical asthma in moderate-severe asthmatic subjects. Fifty-eight patients who had used beclomethasone dipropionate (BDP) over one year, were enrolled in this study. BHR was measured before and after treatment with BDP by the methods recommended by Japanese Society of Allergology. Moreover we examined the clinical factors and the frequency of acute exacerbations. The results as follows: 1) The mean age was 48.8 years and the mean asthma history was 9.2 years. The mean dose and mean time of BDP administration was 801 micrograms/day and 28.1 months, respectively. 2) Patients during BDP treatment over one year showed about 6-fold mean improvements in BHR, but there were many patients who showed no improvements in BHR. 3) We retrospectively divided all the patients into two groups. Namely, the improved group (n = 25) showed more than 4 fold improvement in BHR and unchanged group (n = 33), less than 4-fold. But there were no significant differences in clinical characteristics and %FEV1 during treatment with BDP. 4) The unchanged group had more near fatal episodes in the past than the improved group. 5) There was significant decrease in acute exacerbation during treatment with BDP, but the unchanged group had more acute exacerbations than the improved group during treatment with BDP. These results indicates that there are many patients who had no improvement on BHR with long term BDP treatment and they have more acute exacerbations due to various stimuli. In conclusion, asthma is recognized chronic inflammatory disease and inhaled corticosteroid therapy has been recommended as the first line therapy. We must further study the clinical problems and underlying mechanisms concerning about treatment with an inhaled corticosteroid.
我们回顾性研究了吸入性糖皮质激素长期治疗对中重度哮喘患者支气管高反应性（BHR）和临床哮喘的影响。58例使用丙酸倍氯米松（BDP）超过一年的患者纳入本研究。采用日本变态反应学会推荐的方法在BDP治疗前后测量BHR。此外，我们还检查了临床因素和急性加重的频率。结果如下：1）平均年龄为48.8岁，平均哮喘病史为9.2年。BDP的平均剂量和平均给药时间分别为801微克/天和28.1个月。2）接受BDP治疗一年以上的患者BHR平均改善约6倍，但有许多患者BHR无改善。3）我们将所有患者回顾性分为两组。即改善组（n = 25）BHR改善超过4倍，未改善组（n = 33）改善不足4倍。但在BDP治疗期间，两组的临床特征和%FEV1无显著差异。4）未改善组过去发生的濒死发作比改善组更多。5）BDP治疗期间急性加重显著减少，但未改善组在BDP治疗期间的急性加重比改善组更多。这些结果表明，许多患者长期使用BDP治疗后BHR无改善，且因各种刺激导致急性加重更多。总之，哮喘被认为是一种慢性炎症性疾病，吸入性糖皮质激素治疗已被推荐为一线治疗方法。我们必须进一步研究与吸入性糖皮质激素治疗相关的临床问题和潜在机制。
