CORTICOSTEROID RESISTANCE IN CHRONIC ASTHMA
CORTICOSTEROID RESISTANCE IN CHRONIC ASTHMA
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DOI：
10.1136/bmj.282.6274.1419
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发表时间：
1981-01-01
影响因子：
105.7
通讯作者：
GRANT, IWB
中科院分区：
文献类型：
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作者：
CARMICHAEL, J;PATERSON, IC;GRANT, IWB
对58例经支气管扩张剂气雾剂缓解气流阻塞但口服皮质类固醇无效的慢性哮喘患者与58例对两种治疗反应相同的慢性哮喘患者进行比较。两组在年龄和性别上相匹配。两组之间唯一显著的临床差异是，在皮质类固醇抵抗的患者中，有更频繁的哮喘家族史和更长的症状持续时间。耐药患者早上的呼气峰流速也比当天晚些时候相对较低，并且支气管对乙酰甲胆碱的反应性更高。这些特征可能不是皮质类固醇抵抗的特异性标准，因为它们也在未经治疗的哮喘患者中观察到，这些患者随后对皮质类固醇反应良好。泼尼松龙抑制单核细胞介导的支气管反应的失败可能解释了为什么一些慢性哮喘患者对皮质类固醇没有反应。对皮质类固醇抵抗型哮喘患者应在早期发现，以便停用常规的口服皮质类固醇治疗。如果不这样做，就会导致不必要的暴露于发生严重副作用的风险中。
Patients (58) with chronic asthma in whom airflow obstruction was relieved by bronchodilator aerosols but not by oral corticosteroids were compared with 58 other chronic asthmatics who responded equally well to both treatments. The 2 groups were matched for age and sex. The only significant clinical differences between the 2 groups were that in the corticosteroid-resistant patients there was a more frequent family history of asthma and a longer duration of symptoms. Resistant patients also had a relatively lower peak expiratory flow rate in the morning than later in the day and a greater degree of bronchial reactivity to methacholine. Such features may not be specific criteria of corticosteroid resistance since they were also observed in untreated asthmatics who subsequently responded well to corticosteroids. The failure of prednisolone to inhibit a monocyte-mediated bronchial reaction may explain why some chronic asthmatics do not respond to corticosteroids. Patients with corticosteroid-resistant asthma should be recognized at an early stage so that regular treatment with oral corticosteroids may be withdrawn. Failure to do this results in needless exposure to the risk of developing serious side effects.