吸入性皮质类固醇在喘中的剂量时间的影响:一个随机的三方交叉试验
Ran Wang1,2, Robert Maidstone2, Dave Singh1,2,3
1NIHR Manchester Biomedical Research Centre, Manchester, UK.
Thorax
|April 15, 2025
概括
晚上服用吸入性皮质类固醇 (ODPM) 显著改善肺功能,并降低了喘患者的胆固醇细胞数量,相比于早上或每天两次剂量. 这种慢性治疗方法可以增强喘控制,而不会增加不良事件.
科学领域:
- 肺部病理学 肺部病理学
- 时间生物学 时间生物学
- 药理学 药理学是指药理学的学科.
背景情况:
- 喘表现出明显的每日节奏,呼吸道阻塞和炎症的峰值在一夜之间发生.
- 时间疗法,使药物管理与疾病节奏保持一致,有可能提高喘治疗的疗效.
- 吸入性皮质类固醇 (ICS) 是喘管理的基石,但最佳时间仍在调查中.
研究的目的:
- 评估吸入性皮质类固醇的不同剂量时间对喘控制和肺功能的影响.
- 为了比较每天晚上服用一次 (ODPM) 与每天早上服用一次 (ODAM) 和每天两次 (BD) 服用贝克洛马二 propionate 的疗效.
主要方法:
- 一个随机的,三方交叉试验,涉及轻度至中度的无性喘患者.
- 参与者接受了400μg ODAM,400μg ODPM或200μg BD的贝克洛马二 propionate,持续28天,有2周的洗期.
- 每六小时进行一次螺旋计,在每一个治疗期结束后,在24小时内测量血液中乙酸细胞的数量.
主要成果:
- 与ODAM和BD相比,每天晚上一次的剂量 (ODPM) 显著改善了22:00在1秒内强制呼气体积 (FEV1).
- 与BD和ODAM相比,ODPM表现出在一夜之间更好的抑制血中乙氨基酸细胞数量.
- 所有剂量方案都改善了喘控制,并降低了部分呼出的氧化 (FeNO) 和血清皮质醇水平,没有显著差异.
结论:
- 吸入性皮质类固醇 (ODPM) 的晚上使用更有效地减轻夜间肺功能的下降,并减少喘患者的血中乙氨基酸峰值.
- 这种慢性治疗方法并没有导致不良事件的增加.
- 需要进一步的研究,以在现实环境中验证这些发现,并确定可能从ODPM慢性治疗中受益最多的患者群体.
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