Pethica B D, Penrose A, MacKenzie D, Hall J, Beasley R, Tilyard M
Wellington Asthma Research Group, Wellington School of Medicine, University of Otago, Wellington, PO Box 7343, Wellington South, New Zealand.
BMJ. 1998 Oct 10;317(7164):986-90. doi: 10.1136/bmj.317.7164.986.
To determine whether inhaled budesonide and beclomethasone are equipotent in the treatment of asthma in primary care.
Retrospective study of computerised clinical records from 28 general practices in New Zealand.
5930 patients who received 16 725 prescriptions for inhaled budesonide or beclomethasone from 1 July 1994 to 30 June 1995.
General practices on the database of the Royal New Zealand College of General Practitioners Research Unit. Linked information from secondary care was available for a subset of the practices.
Mean prescribed daily inhaled corticosteroid dose.
The daily prescribed dose was higher for patients receiving inhaled budesonide (mean 979 microg) than beclomethasone (mean 635 microg), a difference of 344 microg (95% confidence interval 313 to 376 microg). This difference was consistent in all age bands and with different types of inhalation device. Evidence of systematic prescribing of higher doses of budesonide to patients with more severe asthma was not found.
In primary care in New Zealand evidence suggests that budesonide is less potent than beclomethasone. Consideration of validated, established, and other possible markers of asthma severity did not support confounding by severity as a reason for the higher prescribed doses of budesonide. Pending further epidemiological evaluation, international asthma guidelines may need to be modified on the equivalence of inhaled corticosteroid doses. Furthermore, the comparative potency of newly developed inhaled steroids in clinical trials will need to be confirmed in appropriately designed epidemiological studies based in general practice.
确定吸入性布地奈德和倍氯米松在基层医疗中治疗哮喘的疗效是否相当。
对新西兰28家全科诊所的计算机化临床记录进行回顾性研究。
1994年7月1日至1995年6月30日期间接受16725份吸入性布地奈德或倍氯米松处方的5930名患者。
新西兰皇家全科医师学院研究单位数据库中的全科诊所。部分诊所可获取二级医疗的相关联信息。
每日吸入性糖皮质激素的平均处方剂量。
接受吸入性布地奈德治疗的患者每日处方剂量（平均979微克）高于倍氯米松（平均635微克），相差344微克（95%置信区间313至376微克）。这一差异在所有年龄组以及不同类型的吸入装置中均一致。未发现有向哮喘更严重患者系统性开具更高剂量布地奈德的证据。
在新西兰的基层医疗中，有证据表明布地奈德的效力低于倍氯米松。对哮喘严重程度的有效、既定及其他可能指标的考量并不支持将严重程度作为布地奈德处方剂量较高的混杂因素。在进一步进行流行病学评估之前，国际哮喘指南可能需要根据吸入性糖皮质激素剂量的等效性进行修改。此外，新开发的吸入性类固醇在临床试验中的相对效力需要在基于全科医疗的适当设计的流行病学研究中得到证实。
