Marabini A, Cardinalini G, Severini C, Ripandelli A, Siracusa A
Department of Clinical Medicine, Pathology, and Pharmacology, University of Perugia, Italy.
Chest. 1998 Apr;113(4):964-7. doi: 10.1378/chest.113.4.964.
Inhaled corticosteroid (ICS) treatment is first-line maintenance therapy in bronchial asthma. However, it is not clear whether and when ICS treatment can be withdrawn. The aim of this open study was to assess whether normalization of bronchial responsiveness could be used as a reliable index to assess the opportunity of ICS treatment withdrawal.
Open study at two different points in time.
Outpatient pulmonary clinic.
Eighteen asthmatic subjects.
ICS therapy was withdrawn in subjects treated with beclomethasone dipropionate, at the maintenance dose of 889+/-246 microg/d for >3 months. Upon recruitment, all subjects were asymptomatic, had FEV1 >70% of predicted value, and were in treatment with beta2-agonists on an as-needed basis. Eight subjects (group 1) had normal bronchial responsiveness (methacholine provocative dose causing a 20% fall in FEV1 [PD20] >2,000 microg) and 10 subjects (group 2) had bronchial hyperresponsiveness (BHR) (PD20 < or = 2,000 microg). After withdrawal of ICS treatment, subjects were followed up for 3 weeks and were asked to record their asthma symptoms (cough, dyspnea, and wheezing) and their beta2-agonist use. At recruitment and at the end of follow-up, subjects underwent spirometry and a methacholine challenge test. Frequency of asthma exacerbation was similar in subjects with normal bronchial responsiveness (NBR) and in subjects with BHR (50% vs 60%), but subjects with NBR tended to remain asymptomatic for longer than those with BHR (mean+/-SD, 10.7+/-4.4 days vs 5.5+/-3.8 days) (p=0.08). None of the subjects reported any condition that could have triggered exacerbation. Asthma exacerbation was associated with a significant decrease in FEV1 (-105+/-107 mL; p<0.05) and in PD20 (-1,332+/-1,020 microg; p<0.001).
Our study shows that the likelihood of asthma exacerbation is not reduced if ICS treatment is withdrawn when the subjects have NBR, but the exacerbation could be delayed. Further studies in larger populations of asthmatics are needed to confirm these findings.
吸入性糖皮质激素（ICS）治疗是支气管哮喘的一线维持治疗方法。然而，目前尚不清楚ICS治疗是否以及何时可以停用。本开放性研究的目的是评估支气管反应性正常化是否可作为评估停用ICS治疗时机的可靠指标。
在两个不同时间点进行的开放性研究。
门诊肺部诊所。
18名哮喘患者。
接受丙酸倍氯米松治疗的患者，以889±246微克/天的维持剂量治疗超过3个月后停用ICS治疗。招募时，所有受试者均无症状，第一秒用力呼气容积（FEV1）>预测值的70%，并按需使用β2受体激动剂进行治疗。8名受试者（第1组）支气管反应性正常（乙酰甲胆碱激发剂量导致FEV1下降20% [PD20]>2000微克），10名受试者（第2组）存在支气管高反应性（BHR）（PD20≤2000微克）。停用ICS治疗后，对受试者进行3周的随访，并要求他们记录哮喘症状（咳嗽、呼吸困难和喘息）以及β2受体激动剂的使用情况。在招募时和随访结束时，受试者接受肺功能测定和乙酰甲胆碱激发试验。支气管反应性正常（NBR）的受试者和存在BHR的受试者哮喘加重的频率相似（50%对60%），但NBR受试者无症状的时间往往比BHR受试者更长（平均值±标准差，10.7±4.4天对5.5±3.8天）（p = 0.08）。没有受试者报告任何可能引发加重的情况。哮喘加重与FEV1显著下降（-105±107毫升；p<0.05）和PD20显著下降（-1332±1020微克；p<0.001）相关。
我们的研究表明，当受试者支气管反应性正常时停用ICS治疗，哮喘加重的可能性并未降低，但加重可能会延迟。需要在更大规模的哮喘患者群体中进行进一步研究以证实这些发现。
