Severe Exacerbations and Decline in Lung Function in Asthma
Severe Exacerbations and Decline in Lung Function in Asthma
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DOI：
10.1164/rccm.200807-1126oc
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发表时间：
2009-01-01
影响因子：
24.7
通讯作者：
Busse, William W.
中科院分区：
文献类型：
--
作者：
O'Byrne, Paul M.;Pedersen, Soren;Busse, William W.
理由：评估哮喘急性发作与肺功能下降之间的关系，以及吸入皮质类固醇布地奈德对哮喘患者急性发作相关下降的潜在影响。目的：确定严重哮喘急性发作是否与肺功能持续下降相关。方法：开始（吸入性类固醇治疗作为早期哮喘的常规治疗）研究是一项为期3年的随机双盲研究，纳入了7,165例持续哮喘不到2年的患者（5-66岁），确定早期低剂量吸入布地奈德干预是否可预防严重哮喘相关事件（需要住院或急诊治疗的加重）和肺功能下降。测量和主要结果：有315例患者至少发生过一次重度哮喘急性发作，其中305例可进行分析，安慰剂组190例，布地奈德组115例。在安慰剂组中，从基线到研究结束，在发生或未发生重度急性发作的患者中，使用支气管扩张剂后FEV1%预测值的变化分别为-6.44%和-2.43%（P < 0.001）。在儿童和成人中均观察到显著差异，但在青少年中没有。在布地奈德组中，发生或未发生重度急性发作的患者使用支气管扩张剂后FEV1%预测值的变化分别为-2.48%和-1.72%（P = 0.57）。布地奈德降低的幅度的差异，在患者谁经历了至少一个严重的哮喘相关事件相比，那些谁没有统计学显着（P = 0.042）。结论：严重哮喘急性发作与肺功能下降更快。低剂量吸入性皮质类固醇治疗与下降的衰减有关。在www.clinicaltrials.gov注册的临床试验（NCT 00641914）。
Rationale: To evaluate the association between asthma exacerbations and the decline in lung function, as well as the potential effects of an inhaled corticosteroid, budesonide, on exacerbation-related decline in patients with asthma.Objectives: To determine whether severe asthma exacerbations are associated with a persistent decline in lung function.Methods: The START (inhaled steroid treatment as regular therapy in early asthma) study was a 3-year, randomized, double-blind study of 7,165 patients (5-66 yr) with persistent asthma for less than 2 years, to determine whether early intervention with low-dose inhaled budesonide prevents severe asthma-related events (exacerbations requiring hospitalization or emergency treatment) and decline in lung function. Measurements and MainResults: There were 315 patients who experienced at least one severe asthma exacerbation, of which 305 were analyzable, 190 in the placebo group and 115 in the budesonide group. In the placebo group, the change in post-bronchodilator FEV1 % predicted from baseline to the end of the study, in patients who did or did not experience a severe exacerbation was -6.44% and -2.43%, respectively (P < 0.001). A significant difference was seen in both children and in adults, but not in adolescents. In the budesonide group, the change in the post-bronchodilator FEV1 % predicted in patients who did or did not experience a severe exacerbation was -2.48% and -1.72%, respectively (P = 0.57). The difference in magnitude of reduction afforded by budesonide, in patients who experienced at least one severe asthma-related event compared with those who did not was statistically significant (P = 0.042).Conclusions: Severe asthma exacerbations are associated with a more rapid decline in lung function. Treatment with low doses of inhaled corticosteroid is associated with an attenuation of the decline. Clinical trial registered with www.clinicaltrials.gov (NCT00641914).