Protection by budesonide and fluticasone on allergen-induced airway responses after discontinuation of therapy
Protection by budesonide and fluticasone on allergen-induced airway responses after discontinuation of therapy
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DOI：
10.1016/j.jaci.2004.11.023
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发表时间：
2005-04-01
影响因子：
14.2
通讯作者：
O'Byrne, PM
中科院分区：
文献类型：
--
作者：
Subbarao, P;Dorman, SC;O'Byrne, PM
背景：吸入类固醇治疗是减轻过敏原激发后支气管收缩和气道炎症的有效方法。然而，吸入性类固醇治疗停止后的保护作用的持续时间尚未建立。目的：我们试图评估吸入性类固醇治疗1周对治疗停止后12小时吸入性变应原激发的保护作用。方法：在这项随机、双盲、安慰剂对照的交叉试验中，26名未使用吸入性类固醇的哮喘受试者（> 18岁）被给予200 μ g布地奈德每日两次、200 μ g氟替卡松每日两次或安慰剂每日两次，持续1周。在停止治疗后12小时，对受试者进行吸入性过敏原激发。结果：与安慰剂相比（26% +/- 14%），氟替卡松治疗后（19% +/-10%，P = 0.001）对过敏原诱导的早期反应有轻微但显著的保护作用，但布地奈德治疗后（23% +/-13%，P = 0.08）则无此作用。然而，当检查早期气道反应曲线下面积时，两种药物的保护量没有差异（P = 0.62）。两种治疗均对迟发反应变应原诱导的痰嗜酸性粒细胞增多症有部分保护作用（P =.001）。相比之下，没有保护观察到对过敏原诱导的气道高反应性任一treatment.Conclusions：吸入性类固醇对过敏原诱导的早期反应，气道嗜酸性粒细胞增多症，过敏原诱导的气道高反应性的保护作用，部分或完全失去早在12小时后停止治疗。
Background: Treatment with inhaled steroids is an effective method of reducing bronchoconstriction and airway inflammation after allergen challenge. However, the duration of the protective effects of inhaled steroids after discontinuation of therapy has not been established.Objective: We sought to evaluate the protective effect of I week of inhaled steroid therapy against inhaled allergen challenge 12 hours after discontinuation of therapy.Methods: In this randomized, double-blind, placebo-controlled crossover trial, 26 asthmatic subjects (> 18 years old) not using inhaled steroids were administered 200 mu g of budesonide twice daily, 200 mu g of fluticasone twice daily, or placebo twice daily for 1 week. Twelve hours after discontinuation of therapy, subjects were administered an inhaled allergen challenge. Each treatment period was separated by a 3-week washout period.Results: When compared with placebo (26% +/- 14%), there was a slight but significant protection against the allergen-induced early response after fluticasone treatment (19% +/- 10%, P =.001) but not after budesonide treatment (23% +/- 13%, P =.08). However, when the area under the curve for the early airway response was examined, there was no difference between the 2 drugs in the amount of protection (P =.62). Partial protection was demonstrated against the late-response allergen-induced sputum eosinophilia with both treatments (P =.001). By contrast, no protection was observed against allergen-induced airway hyperresponsiveness for either treatment.Conclusions: The protective effects of inhaled steroids against allergen-induced early responses, airway eosinophilia, and allergen-induced airway hyperresponsiveness; are partially or completely lost as early as 12 hours after discontinuation of therapy.