A trial of clarithromycin for the treatment of suboptimally controlled asthma.
A trial of clarithromycin for the treatment of suboptimally controlled asthma.
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DOI：
10.1016/j.jaci.2010.07.024
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发表时间：
2010-10
期刊：
影响因子：
--
通讯作者：
National Heart, Lung and Blood Institute's Asthma Clinical Research Network
中科院分区：
文献类型：
--
作者：
Sutherland ER;King TS;Icitovic N;Ameredes BT;Bleecker E;Boushey HA;Calhoun WJ;Castro M;Cherniack RM;Chinchilli VM;Craig TJ;Denlinger L;DiMango EA;Fahy JV;Israel E;Jarjour N;Kraft M;Lazarus SC;Lemanske RF Jr;Peters SP;Ramsdell J;Sorkness CA;Szefler SJ;Walter MJ;Wasserman SI;Wechsler ME;Chu HW;Martin RJ;National Heart, Lung and Blood Institute's Asthma Clinical Research Network
聚合酶链反应（PCR）研究表明，M。肺炎衣原体和C.肺炎在哮喘患者的下呼吸道。在接受低剂量吸入性皮质类固醇（ICS）治疗后仍未得到良好控制的轻度至中度持续性哮喘患者中，检验克拉霉素可改善哮喘控制的假设。丙酸氟替卡松治疗4周后哮喘控制问卷（ACQ）评分≥1.5的成人进入一项PCR分层随机试验，以评价克拉霉素或安慰剂加用氟替卡松16周对有或无下气道PCR证据的哮喘控制的影响。肺炎衣原体或C.肺炎。92名参与者被随机分组。12例（13%）受试者表现出M的PCR证据。pneumoniae或C.支气管内活检中的肺炎; 80例两种微生物PCR阴性。在PCR阳性受试者中，克拉霉素使ACQ评分改善0.4±0.4个单位，安慰剂组改善0.1±0.3个单位。0.3±0.5（p=0.6）的组间差异既无临床意义也无统计学意义。在PCR阴性受试者中，观察到0.2±0.2单位（p=0.3）的非显著组间差异。克拉霉素没有改善肺功能或气道炎症，但改善了气道高反应性，在研究人群中使乙酰甲胆碱PC 20增加了1.2±0.5倍剂量（p=0.02）。在仅用低剂量ICS控制不佳的轻中度持续性哮喘成人中，在氟替卡松基础上添加克拉霉素并不能进一步改善哮喘控制。尽管克拉霉素可改善气道高反应性，但该获益并未伴随其他次要结局的改善。
Polymerase chain reaction (PCR) studies have demonstrated evidence of M. pneumoniae and C. pneumoniae in the lower airways of patients with asthma. To test the hypothesis that clarithromycin would improve asthma control in individuals with mild-to-moderate persistent asthma that was not well-controlled despite treatment with low-dose inhaled corticosteroids (ICS). Adults with an Asthma Control Questionnaire (ACQ) score ≥1.5 after a 4 week period of treatment with fluticasone propionate were entered into a PCR-stratified randomized trial to evaluate the effect of 16 weeks of either clarithromycin or placebo, added to fluticasone, on asthma control in individuals with or without lower airway PCR evidence of M. pneumoniae or C. pneumoniae. 92 participants were randomized. Twelve (13%) subjects demonstrated PCR evidence of M. pneumoniae or C. pneumoniae in endobronchial biopsies; 80 were PCR negative for both organisms. In PCR positive participants, clarithromycin yielded a 0.4±0.4 unit improvement in the ACQ score, with a 0.1±0.3 unit improvement in those allocated to placebo. This between-group difference of 0.3±0.5 (p=0.6) was neither clinically nor statistically significant. In PCR negative participants, a non-significant between-group difference of 0.2±0.2 units (p=0.3) was observed. Clarithromycin did not improve lung function or airway inflammation but did improve airway hyperresponsiveness, increasing the methacholine PC20 by 1.2±0.5 doubling doses (p=0.02) in the study population. Adding clarithromycin to fluticasone in adults with mild-to-moderate persistent asthma that was suboptimally-controlled by low-dose ICS alone did not further improve asthma control. Although there was an improvement in airway hyperresponsiveness with clarithromycin, this benefit was not accompanied by improvements in other secondary outcomes.
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发表时间：
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影响因子：
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