Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease.
Effect of inhaled triamcinolone on the decline in pulmonary function in chronic obstructive pulmonary disease.
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DOI：
10.1056/nejm200012283432601
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发表时间：
2000-12
期刊：
影响因子：
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通讯作者：
R. Wise;J. Connett;G. Weinmann;P. Scanlon;M. Skeans
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文献类型：
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作者：
R. Wise;J. Connett;G. Weinmann;P. Scanlon;M. Skeans
慢性阻塞性肺疾病（COPD）是由肺功能的进行性下降引起的，这被认为是气道炎症的结果。我们推测，吸入性皮质类固醇激素的抗抑郁治疗可以减缓这种下降。方法：我们纳入了1116名COPD患者，他们的第一秒用力呼气量（FEV 1）为预测值的30%至90%，参加了一项10中心、安慰剂对照、随机试验，吸入曲安奈德，剂量为600 μ g，每日两次。主要结果指标是使用支气管扩张剂后FEV 1的下降率。次要结局指标包括呼吸道症状、医疗服务的使用和气道反应性。在412名参与者的子研究中，我们测量了基线和治疗开始后1年和3年的腰椎和股骨骨密度。结果平均随访时间为40个月。使用支气管扩张剂后，559名曲安西龙组受试者和557名安慰剂组受试者的FEV 1下降率相似（44.2+/-2.9 vs. 47.0+/-3.0 ml/年，P= 0.50）。在研究过程中，曲安西龙组的成员呼吸道症状较少（21.1/100人-年vs. 28.2/100人-年，P=0.005），并且由于呼吸道疾病而就诊的次数较少（1.2/100人-年vs. 2.1/100人-年，P=0.03）。服用曲安西龙的患者在9个月和33个月时对乙酰甲胆碱激发的气道反应性也较低（两项比较P=0.02）。三年后，曲安西龙组腰椎和股骨的骨密度显著降低（P <或= 0.007）。结论：吸入曲安奈德并不能减缓COPD患者肺功能下降的速度，但它可以改善气道反应性和呼吸道症状，减少因呼吸道疾病而使用医疗服务。这些益处应与曲安奈德对骨密度的潜在长期不良影响进行权衡。
BACKGROUND Chronic obstructive pulmonary disease (COPD) results from a progressive decline in lung function, which is thought to be the consequence of airway inflammation. We hypothesized that antiinflammatory therapy with inhaled corticosteroids would slow this decline. METHODS We enrolled 1116 persons with COPD whose forced expiratory volume in one second (FEV1) was 30 to 90 percent of the predicted value in a 10-center, placebo-controlled, randomized trial of inhaled triamcinolone acetonide administered at a dose of 600 microg twice daily. The primary outcome measure was the rate of decline in FEV1 after the administration of a bronchodilator. The secondary outcome measures included respiratory symptoms, use of health care services, and airway reactivity. In a substudy of 412 participants, we measured bone density in the lumbar spine and femur at base line and one and three years after the beginning of treatment. RESULTS The mean duration of follow-up was 40 months. The rate of decline in the FEV1 after bronchodilator use was similar in the 559 participants in the triamcinolone group and the 557 participants in the placebo group (44.2+/-2.9 vs. 47.0+/-3.0 ml per year, P= 0.50). Members of the triamcinolone group had fewer respiratory symptoms during the course of the study (21.1 per 100 person-years vs. 28.2 per 100 person-years, P=0.005) and had fewer visits to a physician because of a respiratory illness (1.2 per 100 person-years vs. 2.1 per 100 person-years, P=0.03). Those taking triamcinolone also had lower airway reactivity in response to methacholine challenge at 9 months and 33 months (P=0.02 for both comparisons). After three years, the bone density of the lumbar spine and the femur was significantly lower in the triamcinolone group (P < or = 0.007). CONCLUSIONS Inhaled triamcinolone does not slow the rate of decline in lung function in people with COPD, but it improves airway reactivity and respiratory symptoms and decreases the use of health care services for respiratory problems. These benefits should be weighed against the potential long-term adverse effects of triamcinolone on bone mineral density.