Daily versus as-needed corticosteroids for mild persistent asthma
Daily versus as-needed corticosteroids for mild persistent asthma
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DOI：
10.1056/nejmoa042552
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发表时间：
2005-04-14
影响因子：
158.5
通讯作者：
Israel, E
中科院分区：
文献类型：
--
作者：
Boushey, HA;Sorkness, CA;Israel, E
背景
尽管指南建议对轻度持续性哮喘患者进行每日治疗，但处方模式表明，大多数此类患者间歇性地使用这些所谓的控制疗法。在轻度持续性哮喘患者中，我们评估了在为期一年的时间里，仅依据基于症状的行动计划进行间歇性短疗程糖皮质激素治疗，以及在此基础上联合每日使用吸入性布地奈德或口服扎鲁司特治疗的疗效。
方法
在一项双盲试验中，225名成年人被随机分组。主要结局是早晨呼气峰流量（PEF）。其他结局包括支气管扩张剂治疗前后的一秒用力呼气容积（FEV₁）、病情加重的频率、哮喘控制程度、无症状天数以及生活质量。
结果
三种治疗方法使早晨PEF出现相似的增加（7.1% - 8.3%；约每分钟32升；P = 0.90），哮喘加重的比率也相似（P = 0.24），尽管间歇性治疗组平均一年仅使用布地奈德0.5周。与间歇性治疗或每日扎鲁司特治疗相比，每日布地奈德治疗使支气管扩张剂使用前的FEV₁（P = 0.005）和支气管反应性（P……（此处原文似乎不完整））有更大的改善。
BackgroundAlthough guidelines recommend daily therapy for patients with mild persistent asthma, prescription patterns suggest that most such patients use these so-called controller therapies intermittently. In patients with mild persistent asthma, we evaluated the efficacy of intermittent short-course corticosteroid treatment guided by a symptom-based action plan alone or in addition to daily treatment with either inhaled budesonide or oral zafirlukast over a one-year period.MethodsIn a double-blind trial, 225 adults underwent randomization. The primary outcome was morning peak expiratory flow (PEF). Other outcomes included the forced expiratory volume in one second (FEV(sub 1)) before and after bronchodilator treatment, the frequency of exacerbations, the degree of asthma control, the number of symptom-free days, and the quality of life.ResultsThe three treatments produced similar increases in morning PEF (7.1 to 8.3 percent; approximately 32 liters per minute; P=0.90) and similar rates of asthma exacerbations (P=0.24), even though the intermittent-treatment group took budesonide, on average, for only 0.5 week of the year. As compared with intermittent therapy or daily zafirlukast therapy, daily budesonide therapy produced greater improvements in pre-bronchodilator FEV(sub 1) (P=0.005), bronchial reactivity (P