ADDED SALMETEROL VERSUS HIGHER-DOSE CORTICOSTEROID IN ASTHMA PATIENTS WITH SYMPTOMS ON EXISTING INHALED CORTICOSTEROID
ADDED SALMETEROL VERSUS HIGHER-DOSE CORTICOSTEROID IN ASTHMA PATIENTS WITH SYMPTOMS ON EXISTING INHALED CORTICOSTEROID
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DOI：
10.1016/s0140-6736(94)92996-3
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发表时间：
1994-07-23
期刊：
影响因子：
168.9
通讯作者：
SHAW, G
中科院分区：
文献类型：
--
作者：
GREENING, AP;IND, PW;SHAW, G
哮喘管理指南建议，对于接受低剂量吸入性皮质类固醇治疗仍有症状的患者，第一步应增加吸入性皮质类固醇剂量。另一种选择是增加长效吸入性β 2肾上腺素受体激动剂。我们在一项随机、双盲、平行组试验中比较了这两种策略。我们研究了429例成人哮喘患者，这些患者尽管接受了200 μ g每日两次吸入丙酸倍氯米松（BDP）的维持治疗，但仍有症状。3个没有提供可核实的数据。在其他受试者中，220例被分配沙美特罗xinafoate（50 μ g，每日两次）+BDP，206例被分配较高剂量的BDP（500 μ g，每日两次），持续6个月。两组的平均晨峰呼气流量均较基线增加，但在所有时间点，沙美特罗/BDP组的增加均大于高剂量BDP组（差异16-21 L/min，p < 0.05），沙美特罗/BDP组的平均夜间PEF也增加，但高剂量BDP组无增加。沙美特罗/BDP在PEF的日变化方面存在显着差异，有利于沙美特罗/BDP（所有时间点）和使用补救支气管扩张剂（沙丁胺醇）和白天和夜间症状（某些时间点）。两组之间在哮喘的副作用或加重方面没有显著差异，表明在这组患者中，常规β 2受体激动剂治疗与6个月内哮喘控制恶化的任何风险无关。这项研究表明，需要一个灵活的方法来管理哮喘。
Guidelines on asthma management recommend that in patients who still have symptoms on treatment with low-dose inhaled corticosteroids the first step should be an increase in inhaled corticosteroid dose. The addition of long-acting inhaled beta(2)-adrenoceptor agonists is another option. We have compared these two strategies in a randomised, double-blind, parallel-group trial.We studied 429 adult asthmatic patients who still had symptoms despite maintenance treatment with 200 mu g twice daily inhaled beclomethasone dipropionate (BDP). 3 did not provide verifiable data. Of the others, 220 were assigned salmeterol xinafoate (50 mu g twice daily) plus BDP and 206 were assigned higher-dose BDP (500 mu g twice daily) for 6 months. The mean morning peak expiratory flow increased from baseline in both groups, but the increase was greater in the salmeterol/BDP group than in the higher-dose BDP group at all time points (differences 16-21 L/min, p < 0.05), Mean evening PEF also increased with salmeterol/BDP but not with higher-dose BDP. There were significant differences in favour of salmeterol/BDP in diurnal variation of PEF (all time points) and in use of rescue bronchodilator (salbutamol) and daytime and night-time symptoms (some time points).There was no significant difference between the groups in adverse effects or exacerbations of asthma, indicating that in this group of patients regular beta(2)-agonist therapy was not associated with any risk of deteriorating asthma control over 6 months. This study suggests a need for a flexible approach to asthma management.