摘要
目的探讨沙美特罗丙酸氟替卡松粉吸入治疗重度持续支气管哮喘(以下简称哮喘)的合理降级方案。方法收集2003年5月至2007年3月广西医科大学哮喘专科门诊收治的111例重度哮喘患者,采用单盲、随机方法,将重度哮喘患者随机分为A、B、C、D 4组。A、C组先减少丙酸氟替卡松剂量;B、D组先减少沙美特罗剂量。A、B两组每24周降阶梯治疗,C、D两组每12周降阶梯治疗。每治疗阶梯评估患者哮喘控制水平、肺功能改变情况、哮喘加重、不良反应等发生情况。结果各组经沙美特罗丙酸氟替卡松粉质量分数[20%(50μg/250μg)]吸入治疗4周后,总控制率达90%以上,肺功能较治疗前明显改善。4组各降级阶梯哮喘控制率、肺功能和哮喘加重率比较,差异无统计学意义。感冒是诱发各组哮喘加重的主要原因。4组不良反应发生率均低,以咽干、痰多等局部反应为主。结论用沙美特罗丙酸氟替卡松粉质量分数[20%(50μg/250μg)]吸入治疗重度哮喘总控制率达90%以上。降阶梯治疗时,先减少丙酸氟替卡松剂量或先减少沙美特罗剂量,以及每治疗阶梯维持12周或24周降级,在维持哮喘控制水平、肺功能改善等方面无明显差异;结合总的药物费用考虑,维持12周组降级更有优势。
Objective To explore the optimal strategy for degrading severe persistent asthma with salmeterol fluticasone inhalation.Methods 111 patients with severe persistent asthma,from asthma clinic of Guangxi Medical University during April 2003 and March 2007 were enrolled in the study and randomized in a single blind method into four groups：group A,B,C and D.Treatment in Group A and C began with a decreased dose of fluticasone propionate,while that in Group B and D began with a decreased dose of salmeterol.Group A and B underwent down-stepped care every 24 weeks,while Group C and D underwent every 12 weeks.Asthma symptoms control,respiratory function,exacerbation rate,and adverse events were monitored in each treatment period.Results After the first 4 weeks of inhaling salmeterol fluticasone powder（50 μg/250 μg）,proportion of controlled and partly controlled cases reached over 90%,and pulmonary function improved significantly.No statistically significant difference in asthma control,lung function and exacerbation rate were found in each down-stepped period among the four groups.Adverse event rate in all groups were low,and most adverse events were local reaction such as dry pharynx and excessive phlegm.Conclusion General control rate of asthma was above 90% when treated with salmeterol/fluticasone inhalation（50 μg/250 μg）.In asthma control and pulmonary function improvement,no significant difference was found among groups with first reduced dose of either fluticasone or salmeterol,and among those with 12-week or 24-week down-stepped therapy.While considering treatment expense,12-week down-stepped therapy may be superior.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2010年第12期1101-1103,共3页
Chinese Journal of Practical Internal Medicine
基金
国家自然科学基金(30460051)
