REGULAR INHALED SALBUTAMOL AND AIRWAY RESPONSIVENESS TO ALLERGEN
REGULAR INHALED SALBUTAMOL AND AIRWAY RESPONSIVENESS TO ALLERGEN
复制标题
DOI：
10.1016/0140-6736(93)92695-p
复制
发表时间：
1993-10-02
期刊：
影响因子：
168.9
通讯作者：
RUTHERFORD, BC
中科院分区：
文献类型：
--
作者：
COCKCROFT, DW;MCPARLAND, CP;RUTHERFORD, BC
定期吸入 β2 激动剂会引起对 β2 激动剂对 AMP、组胺和醋甲胆碱等化学刺激引起的支气管收缩的急性保护作用的耐受。我们在一项双盲、交叉、随机顺序试验中，对 13 名至少 4 周未使用 β1 激动剂的轻度特应性哮喘患者进行了双盲、交叉、随机顺序试验，检查了一种更具临床相关性的刺激物，即吸入过敏原。我们比较了常规吸入沙丁胺醇（200 杯，每天四次，持续 2 周）与安慰剂（2 周）对支气管扩张剂反应、基线乙酰甲胆碱和过敏原气道反应性的影响，以及沙丁胺醇对两种刺激的急性保护作用。两个治疗期间的基线 1 秒用力呼气量 (FEV1)、支气管扩张剂反应和乙酰胆碱反应性相同。常规沙丁胺醇治疗后，过敏原 PC20（引起 20% FEV1 下降的激发浓度）在加倍剂量后下降了 0.91 (SD 0.66) (p = 0.0009)，并且沙丁胺醇对醋甲胆碱和过敏原的保护作用均显着降低（分别为 p = 0.026 和 0.025）。考虑到基线过敏原 PC20 的减少，沙丁胺醇治疗期间沙丁胺醇后过敏原 PC20 几乎降低了 2 倍剂量 (1.94 [1.43]，p < 0.01)。因此，定期吸入沙丁胺醇两周会增加气道对过敏原的反应性，但不会增加对醋甲胆碱的反应性，并引起对沙丁胺醇对两种刺激引起的支气管收缩的保护作用的耐受。吸入 β2 激动剂的这些作用提供了进一步的证据来支持其经常使用的有害影响。
Regular inhaled beta2 agonist causes tolerance to the acute protective effect of beta2 agonist against bronchoconstriction induced by chemical stimuli such as AMP, histamine, and methacholine.We examined a more clinically relevant stimulus, inhaled allergen, in a double-blind, cross-over, random-order trial in 13 mild atopic asthmatics, who had not used beta1 agonist for at least 4 weeks. We compared regular inhaled salbutamol (200 mug four times daily for 2 weeks) with placebo (2 weeks) for effects on bronchodilator response, baseline methacholine, and allergen airway responsiveness, and on the acute protective effect of salbutamol against both stimuli. Baseline forced expiratory volume in 1 s (FEV1), bronchodilator response, and methacholine responsiveness were the same during both treatment periods. After regular salbutamol, the allergen PC20 (provocation concentration producing a 20% FEV1 decrease) fell by 0.91 (SD 0.66) (p = 0.0009) doubling doses, and the protective effects of salbutamol on methacholine and allergen were both significantly reduced (p = 0.026 and 0.025, respectively). Taking into account the reduced baseline allergen PC20, the post-salbutamol allergen PC20 was almost 2 doubling doses (1.94 [1.43], p < 0.01) lower during salbutamol treatment. Thus, 2 weeks of regular inhaled salbutamol increased airway responsiveness to allergen but not to methacholine, and caused tolerance to the protective effect of salbutamol on bronchoconstriction induced by both stimuli. These effects of inhaled beta2 agonist provide further evidence to support detrimental effects of their regular use.