长效β2抗原剂单疗与持续治疗持续性喘患者的吸入性皮质类固醇:一个随机对照试验
S C Lazarus1, H A Boushey, J V Fahy
1University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0111, USA. lazma@itsa.ucsf.edu
对于持久性喘,不建议从吸入性皮质类固醇转换为单独的长期活性β2-激动剂. 与持续吸入类皮质类固醇使用相比,萨尔米特单一治疗导致了更多的喘恶化和呼吸道炎症.
科学领域:
- 肺部病理学 肺部病理学
- 临床药理学 临床药理学
- 喘治疗方法 喘治疗方法
背景情况:
- 持续性喘管理通常涉及吸入性皮质类固醇 (ICS).
- 长效β2-激动剂 (LABAs) 有时在没有ICS的情况下使用,但缺乏单一治疗的证据.
- 在控制良好的喘中用LABAs取代ICS的有效性需要研究.
研究的目的:
- 评价沙米特醇新酸盐 (LABA) 作为低剂量吸入式三氨乙化物 (ICS) 的替代疗法,用于患有持续性喘的成年人.
- 为了确定沙米特醇单一治疗是否能保持喘控制,当ICS被撤回.
主要方法:
- 一个为期28周的随机,盲目,安慰剂对照试验.
- 164名患有持续性喘的成年患者被随机分类,这些患者在吸入式氨 (400毫克两日一次) 上得到了良好的控制.
- 这些组持续接受三氨,沙米特醇 (42毫克两次),或安慰剂16周.
主要成果:
- 沙米特醇和三氨组之间在PEF,FEV,喘症状或生活质量方面没有显著差异.
- 与三氨相比,萨尔米特醇组的治疗失败率显著增加 (24%vs6%) 和喘恶化率 (20%vs7%).
- 在沙米特醇组中观察到液中异氨基,异氨基酸蛋白和试酶的增加,这表明呼吸道炎症.
结论:
- 将持久性喘患者,在低剂量ICS上得到良好控制,转换为沙米特醇单疗法,可能会导致喘控制的显著损失.
- 在这种患者群体中,单一治疗salmeterol并不是ICS的安全或有效替代品.
- 持续的ICS治疗对于在低剂量吸入式氨稳定患者中保持喘控制至关重要.
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