Sputum eosinophilia and the short term response to inhaled mometasone in chronic obstructive pulmonary disease
Sputum eosinophilia and the short term response to inhaled mometasone in chronic obstructive pulmonary disease
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DOI：
10.1136/thx.2004.032516
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发表时间：
2005-03-01
期刊：
影响因子：
10
通讯作者：
Bradding, P
中科院分区：
文献类型：
--
作者：
Brightling, CE;McKenna, S;Bradding, P
背景资料：在慢性阻塞性肺疾病（COPD）患者中，痰嗜酸性粒细胞计数与泼尼松龙2周疗程的反应之间存在相关性。是否对吸入性皮质类固醇的反应与嗜酸性粒细胞炎症的存在有关尚不清楚。方法：安慰剂和糠酸莫米松（800毫克/天），每给6周，4周的洗脱期，进行随机，双盲，交叉试验与支气管扩张剂治疗的COPD受试者。肺功能测试，症状评分，慢性呼吸道疾病问卷（CRQ），并诱导痰进行之前和之后的每个治疗phase.Results：90 5例患者被招募，其中60例被随机。总体而言，1秒用力呼气量（FEV 1）、总CRQ或痰液特征无治疗相关变化。在按基线嗜酸性粒细胞计数分层为三分位数后，与安慰剂相比，莫米松组使用支气管扩张剂后FEV 1的净改善从嗜酸性粒细胞最少的三分位数逐渐增加到最多的三分位数。在最高三分位数中，莫米松与安慰剂相比使用支气管扩张剂后FEV 1的平均变化为0.11 l（95%CI 0.03 - 0.19）。这种改善与痰嗜酸性粒细胞计数下降无关。结论：COPD患者吸入莫米松治疗后，痰嗜酸性粒细胞计数增加与支气管扩张剂后FEV 1改善相关，但改善与痰嗜酸性粒细胞计数减少无关。
Background: An association between the sputum eosinophil count and the response to a 2 week course of prednisolone has previously been reported in patients with chronic obstructive pulmonary disease ( COPD). Whether the response to inhaled corticosteroids is related to the presence of eosinophilic inflammation is unclear.Methods: A randomised, double blind, crossover trial of placebo and mometasone furoate ( 800 mg/day), each given for 6 weeks with a 4 week washout period, was performed in subjects with COPD treated with bronchodilator therapy only. Spirometric tests, symptom scores, chronic respiratory disease questionnaire (CRQ), and induced sputum were performed before and after each treatment phase.Results: Ninety five patients were recruited of which 60 were randomised. Overall there were no treatment associated changes in forced expiratory volume in 1 second ( FEV1), total CRQ, or sputum characteristics. After stratification into tertiles by baseline eosinophil count, the net improvement in post-bronchodilator FEV1 increased with mometasone compared with placebo progressively from the least to the most eosinophilic tertile. The mean change in post- bronchodilator FEV1 with mometasone compared with placebo in the highest tertile was 0.11 l ( 95% CI 0.03 to 0.19). This improvement was not associated with a fall in the sputum eosinophil count.Conclusions: An increased sputum eosinophil count is related to an improvement in post- bronchodilator FEV1 following treatment with inhaled mometasone in COPD, but the improvement is not associated with a reduction in the sputum eosinophil count.