Tan W C, Koh T H, Hay C S, Taylor E
Department of Medicine, National University of Singapore, Singapore.
Respirology. 1998 Mar;3(1):13-20. doi: 10.1046/j.1440-1843.1998.d01-6.x.
The effectiveness of inhaled corticosteroids in the control of daytime symptoms in asthma is well established, but the specific use against nocturnal asthma has not been systematically studied in Asian patients. This study examined the effect of treatment with inhaled budesonide on the nocturnal variation in measurements of airway calibre, bronchial hyperresponsiveness to inhaled histamine and circulating neutrophil chemotactic activity in Asian patients with nocturnal asthma. Thirty patients, with nocturnal asthma, were randomized into a 2-month, double-blind, parallel group study. Twice as many subjects were allocated to the group who received two consecutive months of inhaled budesonide 1600 microg daily as to the group who received placebo followed by budesonide. Spirometry, lung mechanics, bronchial hyperresponsiveness and serum neutrophil chemotactic factor (NCA) were measured at 16.00 h, 22.00 h and at 04.00 h on 3 days and nights, 4 weeks apart before and after either placebo or budesonide. The combined measurements for the two groups at 04.00 h before and after treatment with budesonide were: forced expiratory volume in 1 s (FEV1) mean (SEM) litres 1.34 (0.17) before, 2.00 (0.19) after; thoracic gas volume (TGV) litres 3.05 (0.32) before, 2.25 (0.14) after; specific airway conductance (sGaw) (cmH20.0 sec)(-1) 0.39 (0.07) before, 1.16 (0.17) after; PD20 microg geometric mean 1.16 before, 44.74 after; neutrophil chemotactic activity (NCA) in units of graduations of migration 98.8 (4.2) before, 101 (14.2) after. The data showed that short and intermediate term high dose inhaled budesonide is an effective specific treatment for nocturnal asthma in Asian patients, resulting in marked improvements in symptoms and in lung mechanics, and reductions in the diurnal variations in bronchial hyperresponsiveness, before any change could be demonstrated in a circulating marker of airway inflammation.
吸入性糖皮质激素对控制哮喘日间症状的有效性已得到充分证实，但针对亚洲患者夜间哮喘的具体应用尚未进行系统研究。本研究探讨了吸入布地奈德治疗对亚洲夜间哮喘患者气道管径测量的夜间变化、对吸入组胺的支气管高反应性以及循环中性粒细胞趋化活性的影响。30例夜间哮喘患者被随机分为一项为期2个月的双盲平行组研究。接受连续两个月每日吸入1600微克布地奈德的组分配的受试者数量是接受安慰剂后再接受布地奈德组的两倍。在安慰剂或布地奈德治疗前后，分别于16:00、22:00和04:00在3个白天和夜晚进行测量，间隔4周，测量肺功能、肺力学、支气管高反应性和血清中性粒细胞趋化因子（NCA）。布地奈德治疗前后两组在04:00的综合测量结果为：第1秒用力呼气量（FEV1）平均（SEM）升，治疗前1.34（0.17），治疗后2.00（0.19）；胸腔气体容积（TGV）升，治疗前3.05（0.32），治疗后2.25（0.14）；比气道传导率（sGaw）（cmH20.0秒）（-1），治疗前0.39（0.07），治疗后1.16（0.17）；PD20微克几何均值，治疗前1.16，治疗后44.74；中性粒细胞趋化活性（NCA），以迁移刻度单位计，治疗前98.8（4.2），治疗后101（14.2）。数据表明，短期和中期高剂量吸入布地奈德是亚洲患者夜间哮喘的一种有效特异性治疗方法，可显著改善症状和肺力学，并减少支气管高反应性的昼夜变化，而此时气道炎症的循环标志物尚未出现任何变化。
