Inhaled corticosteroids as additional treatment in alpha-1-antitrypsin-deficiency-related COPD
Inhaled corticosteroids as additional treatment in alpha-1-antitrypsin-deficiency-related COPD
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DOI：
10.1159/000119718
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发表时间：
2008-01-01
期刊：
影响因子：
3.7
通讯作者：
Tantucci, Claudio
中科院分区：
文献类型：
--
作者：
Corda, Luciano;Bertella, Enrica;Tantucci, Claudio
背景：关于吸入皮质类固醇（ICS）对α(1)-抗胰蛋白酶缺乏症（AATD）相关COPD的影响，尚无一致的数据。最近的数据报道了α(1) -抗胰蛋白酶聚合物对周围肺的炎症作用。目的：本研究的目的是评估质量中位空气动力学直径为1.1 μ m的超细ICS -氢氟烷烃-134a二丙酸倍氯米松（HFA-BDP）在加入长效支气管扩张剂（LABAs）时对COPD合并AATD患者肺功能和运动耐量的影响。方法：在为期1周的洗脱期后，在一项双盲随机交叉研究中，8名未使用类固醇的AATD （ZZ基因型）COPD患者被分配到以下16周的治疗方案之一：(1)HFA-BDP 400 μ g / d，沙美特罗50 μ g / d，溴化氧200 μ g / d或(2)安慰剂，沙美特罗50 μ g / d，溴化氧200 μ g / d；在两周的洗脱期后，他们接受了另一种治疗。在第1周、第17周、第19周和第35周，患者进行肺活量测定（呼吸空气和呼吸频率）和穿梭行走试验（SWT），并采用改良Borg量表评估呼吸困难。结果：两种治疗组在SWT期间FEV1、FVC、IC、覆盖距离和呼吸困难的改善与基线值有显著差异（p < 0.05； Friedman检验）。然而，进一步分析显示，只有LABAs + ICS组在SWT期间FEV1、FVC、IC、Delta MEF50%和覆盖距离显著增加，最大等步用力呼吸困难减少（p < 0.05； Wilcoxon检验）。在SWT结束时，LABA + ICS比LABAs单独行走的距离更大（301 +/- 105比270 +/- 112 m； p < 0.05）。结论：在aatd相关的COPD患者（ZZ基因型）中，在LABAs中加入超细ICS可减少气道狭窄，主要是在小气道中，进一步减少动态恶性膨胀，显著改善运动耐量和呼吸困难，提示外周炎症过程有助于这些患者的气流阻塞。版权所有2008 S. Karger AG，巴塞尔
Background: No consistent data are available regarding the effect of inhaled corticosteroids (ICS) in alpha(1)-antitrypsin-deficiency (AATD)-related COPD. Recent data report inflammatory effects of the polymers of alpha(1) -antitrypsin on the peripheral lung. Objectives: The aim of this study was to assess the effectiveness of an extra-fine ICS, hydrofluoroalkane-134a beclometasone dipropionate (HFA-BDP) with a mass median aerodynamic diameter of 1.1 mu m, on lung function and exercise tolerance in COPD patients with AATD when added to long-acting bronchodilators (LABAs). Methods: After a 1-week washout, 8 steroid-nave COPD patients with AATD (ZZ genotype), within a double-blind randomized cross-over study, were assigned to one of the following 16-week treatments: (1) HFA-BDP 400 mu g b.i.d., salmeterol 50 mu g b.i.d. and oxitropium bromide 200 mu g t.i.d. or (2) placebo, salmeterol 50 mu g b.i.d. and oxitropium bromide 200 mu g t.i.d; after a 2-week washout period they received the other treatment. In weeks 1, 17, 19 and 35, patients took a spirometry assessment (breathing air and heliox) and a shuttle walking test (SWT) with dyspnea assessed by the modified Borg scale. Results: Significant differences in improvement were found in FEV1, FVC, IC, distance covered and dyspnea perceived during SWT between the 2 treatments and baseline values (p < 0.05; Friedman's test). However, further analysis showed that only the LABAs + ICS condition showed significant increases in the FEV1, FVC, IC, Delta MEF50% and distance covered during SWT along with a reduction in maximum isostep exertional dyspnea (p < 0.05; Wilcoxon test). A greater distance was walked at the end of the SWT with LABA + ICS than LABAs alone (301 +/- 105 vs. 270 +/- 112 m; p < 0.05). Conclusions: In AATD-related COPD patients (ZZ genotype) the addition of extra-fine ICS to LABAs decreases airway narrowing, mostly in the small airways, further reducing dynamic hyperinflation with a marked improvement in exercise tolerance and dyspnea, suggesting that a peripheral inflammatory process contributes to airflow obstruction in these patients. Copyright (C) 2008 S. Karger AG, Basel.