应根据症状的频率开始吸入类皮质固醇治疗的建议:START研究的后期疗效分析
Helen K Reddel1, William W Busse2, Søren Pedersen3
1Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, NSW, Australia.
Lancet (London, England)
|December 4, 2016
概括
低剂量吸入性皮质类固醇 (ICS) 有效地减少了轻度喘的喘恶化和肺功能下降,无论症状的频率如何. 这些发现挑战了目前的指导方针,该指导方针只建议每周出现两天以上的症状.
科学领域:
- 肺病学
- 临床药理学
- 喘研究
背景情况:
- 目前的指导方针建议在每周出现2天以上的喘症状时使用吸入式皮质类固醇 (ICS),但支持这一门的证据有限.
- 低剂量药物可有效降低喘恶化和死亡率.
研究的目的:
- 评估基于症状的切断值在开始ICS治疗时的有效性.
- 评估在不同起始症状频率的轻度喘中与安慰剂的反应差异.
主要方法:
- 对为期3年的吸入类固醇治疗作为常规疗法 (START) 后期分析.
- 随机,双盲,安慰剂对照试验,涉及轻度,最近出现的喘患者.
- 研究了严重喘相关事件 (SARE) 的时间,肺功能变化和症状控制,分析了与基线症状频率的相互作用.
主要成果:
- 在所有症状频率小组 (0-1,>1-2,>2天/ 周) 中,布德索尼德显著降低了SARE风险,减缓了肺功能衰退,并改善了症状控制.
- 对于初级结局,没有发现布德索尼德的疗效与症状频率的显著相互作用.
- 不管症状的频率如何,重度恶化减少,支气管扩展前的肺功能更高,无症状日数增加.
结论:
- 在轻度喘中,不论症状的频率如何,低剂量布德索尼德在减少恶化,保持肺功能和改善症状控制方面都具有一致的益处.
- 这些发现表明,目前仅基于症状频率的ICS启动标准可能过于严格.
- 对轻度喘的治疗建议应考虑症状负担和潜在的恶化风险降低.
相关概念视频
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
1.8K
Inhaled corticosteroids (ICS) are anti-inflammatory drugs used primarily in treating persistent asthma and providing long-term maintenance. They target the bronchial mucosa, the lining of the airways, to control inflammation, a critical factor in asthma progression and exacerbation.
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
1.8K
01:30Asthma-IV: Diagnostic and Management
3.3K
The diagnosis and management of asthma are comprehensive, encompassing clinical assessments, lung function tests, and pharmacological interventions. Here's an overview:
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
3.3K
01:26COPD: Management Using Bronchodilators and Corticosteroids
1.0K
Chronic obstructive pulmonary isease (COPD) involves a group of progressive lung disorders characterized by persistent airflow limitation and chronic respiratory symptoms. Asthma-COPD Overlap Syndrome (ACOS), encompassing features of both asthma and Chronic obstructive pulmonary disease (COPD), is a group of progressive lung disorders that includes chronic bronchitis, emphysema, and refractory (non-reversible) asthma. ACOS leads to complex clinical presentations that combine the inflammatory...
1.0K
01:23Inhaled Medications
942
Inhaled medications are crucial for managing chronic obstructive pulmonary disease (COPD) and asthma. They are essential for effective treatment and control, ensuring optimal respiratory health and well-being. Inhaled medication delivers drugs directly to the lungs, providing a rapid onset of action and reducing systemic side effects compared to oral or injectable medications. Three primary types of inhalation devices are used to administer these medications: nebulizers, metered-dose inhalers...
942
01:17Drugs Used in Lower Respiratory Disorders: Overview
1.4K
Lower respiratory tract disorders present challenges that often require skilled and nuanced approaches for effective management. Common ailments, such as asthma and chronic obstructive pulmonary disease (COPD), have prompted the development of intricate treatment strategies involving bronchodilators and anti-inflammatory drugs, each tailored to ease breathing and revitalize the lungs.
Bronchodilators, the first step of respiration enhancement, come in various forms, each with its own mechanism...
Bronchodilators, the first step of respiration enhancement, come in various forms, each with its own mechanism...
1.4K
01:29Asthma-I: Introduction
3.6K
Asthma is a chronic respiratory ailment that requires careful management due to its varying symptoms and influencing factors. It is characterized by airway inflammation, bronchial hyperresponsiveness, and reversible airflow obstruction, leading to symptoms like wheezing, shortness of breath, chest tightness, and coughing. The symptom frequency and intensity may vary considerably over time. It is also linked to immune system responses to allergens and irritants, highlighting the complex...
3.6K