The role of intrinsic efficacy in determining response to a beta2-agonist in acute severe asthma.
The role of intrinsic efficacy in determining response to a beta2-agonist in acute severe asthma.
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内在功效在确定急性重症哮喘中β2受体激动剂反应中的作用。
DOI：
10.1016/j.rmed.2006.08.023
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发表时间：
2007
影响因子：
4.3
通讯作者：
Dickey,BurtonF
中科院分区：
文献类型：
--
作者：
Hanania,NicolaA;Moore,RobertH;Zimmerman,JaniceL;Miller,CharlesT;Bag,Remzi;Sharafkhaneh,Amir;Dickey,BurtonF
目前的指南建议在急性哮喘的紧急治疗中重复使用沙丁胺醇。然而，大约三分之一的患者表现出很少或没有初步反应，这部分β2-agonist.METHODSWe进行了一项随机，双盲，概念验证研究，以调查是否完全β2-激动剂，异丙肾上腺素，提供了一个治疗优势，在成人急性严重哮喘（FEV 1 <50%）谁不响应的初步治疗的部分β2-激动剂，沙丁胺醇。研究受试者随机接受沙丁胺醇（7.5mg/h）（n=10，平均FEV 1 =37%预测值）或异丙肾上腺素（7.5mg/h）（n=9，平均FEV 1 =33%预测值）2小时连续雾化。收集呼吸系统症状、生命体征和肺功能指标。两个治疗组的受试者具有相似的基线特征。接受异丙肾上腺素治疗的受试者在60和120 min时FEV 1较基线的改善百分比显著高于接受沙丁胺醇治疗的受试者（分别为44 vs. 17%和63 vs. 24%，P<0.05）。用改良的博格评分测量的症状变化在接受异丙肾上腺素的受试者中也显著更大（P<0.01）。两种治疗均耐受良好，尽管60和120分钟时脉率的平均增加（21 vs. 1和23 vs. 6 beats/min，P<0.05）和120 min时血清钾的平均变化（−0.52 vs. −0.07meq/L，P<0.05）结论：我们的数据表明，在急性重度哮喘患者中，对于沙丁胺醇的初始反应，使用具有更高内在功效的β2-激动剂可以更有效地改善肺功能和症状。
BACKGROUNDCurrent guidelines recommend repeated doses of albuterol for the emergency treatment of acute asthma. However, approximately one-third of patients show little or no initial response to this partial β2-agonist.METHODSWe conducted a randomized, double-blind, proof-of-concept study to investigate whether a full β2-agonist, isoproterenol, offers a therapeutic advantage in adults presenting with acute severe asthma (FEV1<50%) who fail to respond to an initial treatment of the partial β2-agonist, albuterol. Study subjects were randomized to receive a 2-h continuous nebulization of either albuterol (7.5mg/h) (n=10, mean FEV1=37% predicted) or isoproterenol (7.5mg/h) (n=9, mean FEV1=33% predicted). Respiratory symptoms, vital signs and pulmonary function measures were collected.RESULTSSubjects from both treatment groups had similar baseline characteristics. The percent improvements from baseline FEV1at 60 and 120min were significantly higher in subjects receiving isoproterenol than those receiving albuterol (44 vs. 17% and 63 vs. 24%, respectively, P<0.05). The change in symptoms measured by the modified Borg score was also significantly greater in subjects receiving isoproterenol (P<0.01). Both treatments were well tolerated, though the mean increase in pulse rate at 60 and 120min (21 vs. 1 and 23 vs. 6beats/min, respectively, P<0.05) and the mean change in serum potassium at 120min (−0.52 vs. −0.07meq/L, P<0.05) from baseline were significantly greater in the isoproterenol group.CONCLUSIONSOur data suggest that in subjects presenting with acute severe asthma who fail to show an initial response to albuterol, the use of a β2-agonist of higher intrinsic efficacy can be more effective in improving lung function and symptoms.