EFFECT OF AN INHALED CORTICOSTEROID ON AIRWAY INFLAMMATION AND SYMPTOMS IN ASTHMA
EFFECT OF AN INHALED CORTICOSTEROID ON AIRWAY INFLAMMATION AND SYMPTOMS IN ASTHMA
复制标题
DOI：
10.1164/ajrccm/145.3.669
复制
发表时间：
1992-03-01
期刊：
影响因子：
--
通讯作者：
HOLGATE, ST
中科院分区：
文献类型：
--
作者：
DJUKANOVIC, R;WILSON, JW;HOLGATE, ST
对10例哮喘患者进行吸入糖皮质激素治疗，观察其对气道黏膜炎症的影响。 在吸入二丙酸倍氯米松（2，000 μ g/天，持续2周，随后1，000 μ g/天，持续4周）治疗6周之前和之后，通过纤维支气管镜进行支气管内活检。 治疗后，平均晨间最大呼气流量（p < 0.05）和乙酰甲胆碱激发当天测量的基线FEV 1（p < 0.05）显著增加，哮喘症状（p < 0.01）、最大呼气流量变异（p < 0.05）和沙丁胺醇使用（p < 0.05）减少。 这伴随着气道反应性降低7倍（p = 0.001）。 哮喘的临床改善与上皮和粘膜肥大细胞、嗜酸性粒细胞和粘膜下T淋巴细胞的显著减少（p < 0.05）相关，但电子显微镜检查未发现治疗后肥大细胞和嗜酸性粒细胞脱粒程度的任何变化。 由于炎症细胞数量的减少与哮喘的所有临床和生理指标的改善之间存在相关性，我们认为吸入性皮质类固醇在哮喘中的有益作用可能归因于其在支气管粘膜中的抑制作用。
The effect of inhaled corticosteroid therapy on airway mucosal inflammation was investigated in 10 symptomatic atopic asthmatic patients treated with inhaled albuterol and whose disease severity required preventative antiinflammatory treatment. Endobronchial biopsies were obtained by fiberoptic bronchoscopy before and after 6 wk of therapy with inhaled beclomethasone dipropionate (2,000-mu-g/day for 2 wk followed by 1,000-mu-g/day for 4 wk). Following treatment, there was a significant increase in mean morning peak expiratory flow (p < 0.05) and baseline FEV1 measured on the day of methacholine challenge (p < 0.05) and a decrease in asthma symptoms (p < 0.01), peak expiratory flow variation (p < 0.05), and albuterol usage (p < 0.05). This was accompanied by a sevenfold decrease in airway responsiveness (p = 0.001). The clinical improvement in asthma was associated with a significant (p < 0.05) reduction in epithelial and mucosal mast cells and eosinophils and submucosal T lymphocytes, but electron microscopy did not identify any changes in the extent of mast cell and eosinophil degranulation following treatment. Because of the association between the decrease in inflammatory cell numbers and the improvement in all the measured clinical and physiologic indices of asthma, we suggest that the beneficial effect of inhaled corticosteroids in asthma may be attributed to their antiinflammatory action in the bronchial mucosa.