DIFFERENT EFFECTS OF NASAL AND BRONCHIAL GLUCOCORTICOSTEROID ADMINISTRATION ON BRONCHIAL HYPERRESPONSIVENESS IN PATIENTS WITH ALLERGIC RHINITIS
DIFFERENT EFFECTS OF NASAL AND BRONCHIAL GLUCOCORTICOSTEROID ADMINISTRATION ON BRONCHIAL HYPERRESPONSIVENESS IN PATIENTS WITH ALLERGIC RHINITIS
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DOI：
10.1164/ajrccm/146.1.122
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发表时间：
1992-07-01
期刊：
影响因子：
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通讯作者：
HERMAN, D
中科院分区：
文献类型：
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作者：
AUBIER, M;LEVY, J;HERMAN, D
上呼吸道疾病，特别是过敏性鼻炎，通常与支气管高反应性有关。后者可能是由于鼻后滴注或介质或趋化因子进入下气道，直接改变气道反应性或引起气道炎症。本研究的目的是比较相同剂量鼻腔或支气管皮质类固醇给药对变应性鼻炎患者支气管高反应性的影响。对11例患者进行了研究。根据对常见过敏原的皮肤试验阳性判断为特应性。在对照组，测量肺活量、流量-体积曲线和特定气道电导（SGaw）。然后在增加氯乙醇浓度的情况下进行支气管刺激，并构建剂量-反应曲线。从剂量-反应曲线内插确定了使SGaw比基线降低35% （PD35）的苯酚浓度。每隔1周重复一次对照测量，以确保所有患者的PD35稳定。然后，患者以双盲随机交叉方式接受为期2周的局部用药，将400 μ g二丙酸倍氯米松(B)气雾剂（100 μ g，每天4次）滴入鼻腔或支气管。在每个试验期间，使用相同的安慰剂喷雾，后者被施用于鼻子，B被施用于支气管，反之亦然。然后在鼻内给药2周和支气管内给药2周后进行测量。在两个对照期内，所有患者的基线功能数据正常，支气管高反应性明显且稳定，第一和第二对照期PD35分别为30 +/- 7和31 +/- 6 μ -g（正常值> 160 μ -g）。经鼻B治疗2周后，PD35显著升高，平均为75 +/- 12 μ g (p < 0.001)，而经支气管B治疗2周后，PD35无显著变化。经鼻或支气管B治疗后，基线肺功能和SGaw（即支气管攻击前）无显著变化。这些数据表明，局部鼻内给药B对变应性鼻炎患者的乙醇反应性有重要的保护作用，而相同剂量的B下气道给药则没有作用。
Disorders of the upper respiratory tract, particularly allergic rhinitis, are commonly associated with bronchial hyperresponsiveness. The latter may be due to postnasal drip or to mediator or chemotactic factors into the lower airways that either directly alter airway reactivity or cause airway inflammation. The aim of this study was to compare the effect of an identical dose of nasal or bronchial corticosteroid administration on bronchial hyperresponsiveness in patients with allergic rhinitis. Eleven patients were studied. All of them were judged atopic on the basis of positive skin tests to common allergens. During control, spirometry, flow-volume curves, and specific airway conductance (SGaw) were measured. Bronchial challenges were then performed with increasing concentrations of carbachol, and dose-response curves were constructed. The concentration of carbachol that decreased SGaw by 35% from baseline (PD35) was determined by interpolating from the dose-response curve. Control measurements were repeated st 1-wk intervals to ensure that PD35 was stable in all the patients. Then the patients received for 2 wk, in a double-blind randomized crossover fashion, a topical administration of either an aerosol of 400-mu-g of beclomethasone dipropionate (B) into the nose (100-mu-g four times per day) or into the bronchi. During each trial period, identical sprays of placebo were used, the latter being administered into the nose when B was administered into the bronchi and vice versa. Measurements were then performed after 2 wk of intranasal administration and after 2 wk of intrabronchial administration. During both control periods all patients had normal baseline function data and showed marked and stable bronchial hyperresponsiveness, PD35 amounting to 30 +/- 7 and 31 +/- 6-mu-g of carbachol at first and second control periods, respectively (normal value > 160-mu-g). After 2 wk of intranasal B, PD35 increased markedly, averaging 75 +/- 12-mu-g (p < 0.001), whereas no significant change in PD35 was noted after 2 wk of intrabronchial B. No significant change in baseline lung function and SGaw (i.e., before bronchial challenge) was noted after intranasal or Intrabronchial B administration. These data show that topical intranasal administration of B has an Important protective effect on carbachol responsiveness In patients with allergic rhinitis, whereas the same dose of B administered into the lower airways had no effect.