Effects of regular treatment with combination of salmeterol/fluticasone propionate and salmeterol alone in cough variant asthma
Effects of regular treatment with combination of salmeterol/fluticasone propionate and salmeterol alone in cough variant asthma
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DOI：
10.3109/02770903.2014.975358
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发表时间：
2015-01-01
影响因子：
1.9
通讯作者：
Tamaoki, Jun
中科院分区：
文献类型：
--
作者：
Tagaya, Etsuko;Kondo, Mitsuko;Tamaoki, Jun
目的：咳嗽变异性哮喘（CVA）是慢性咳嗽的重要病因，其病理生理特征与典型哮喘相似。由于CVA被认为是哮喘的前兆，因此建议使用长期抗炎药进行早期干预。然而，吸入性皮质类固醇和β（2）-激动剂联合治疗CVA的作用尚未阐明。为了评价联合治疗的有效性，我们研究了沙美特罗/丙酸氟替卡松联合（SFC）和吸入沙美特罗（SAL）单独治疗CVA患者的临床影响。方法：本研究为随机、对照、平行组、多中心临床试验。43名CVA患者被分配到SFC（50/100 μ g，每日一次）或SAL（50 μ g，每日两次）治疗12周。然后，在接下来的24周内停止这些药物。主要观察指标为咳嗽症状、肺功能和气道炎症。结果如下：SFC和SAL治疗均显着降低咳嗽评分并增加FEV 1和PEF，其中SFC的疗效比SAL更明显。SFC还降低痰嗜酸性粒细胞计数和嗜酸性粒细胞阳离子蛋白含量，而SAL没有影响。停药后，咳嗽评分增加，肺功能和嗜酸性气道炎症加重，并恢复到基线水平。结论：SFC维持治疗可进一步改善咳嗽症状、肺功能和气道炎症，停止治疗会导致疾病恶化，这表明停止或中断抗炎治疗对CVA患者可能不可取。
Objective: Cough variant asthma (CVA) is an important cause of chronic cough, and pathophysiological features of the disease appear to be similar to typical asthma. Because CVA is recognized as a precursor of asthma, early intervention with long-term anti-inflammatory agents may be recommended. However, the role of combination therapy with inhaled corticosteroid and beta(2)-agonist in the treatment of CVA has not been elucidated. To evaluate the effectiveness of the combination therapy, we investigated the clinical impact of regular treatment with salmeterol/fliticasone propionate combination (SFC) and inhaled salmeterol (SAL) alone in patients with CVA. Methods: The study was a randomized, controlled, parallel-group multi-center trial. Forty-three CVA patients were assigned to SFC (50/100 mu g once daily) or SAL (50 mu g twice daily) for 12 weeks. Then, these medications were stopped for the next 24 weeks. Main outcome measures were cough symptoms, pulmonary function and airway inflammation. Results: Treatment with each of SFC and SAL significantly decreased cough scores and increased FEV1 and PEF, where the efficacy was more pronounced with SFC than SAL. SFC also decreased sputum eosinophil counts and eosinophil cationic protein contents, whereas SAL had no effect. After discontinuation of the treatment, cough scores increased, pulmonary function and eosinophilic airway inflammation were aggravated and returned to the baseline levels. Conclusions: Maintenance therapy with SFC provides further improvements in cough symptoms, pulmonary function and airway inflammation, and discontinuation of the therapy causes worsening of the disease, indicating that stopping or interrupting anti-inflammatory therapy may not be advisable in patients with CVA.