Inhaled Corticosteroids.
Inhaled Corticosteroids.
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DOI：
10.3390/ph3030514
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发表时间：
2010-03-08
期刊：
影响因子：
--
通讯作者：
Barnes PJ
中科院分区：
文献类型：
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作者：
Barnes PJ
吸入性皮质类固醇（ICS）是哮喘最有效的控制剂。它们主要通过募集组蛋白去乙酰化酶2（HDAC2）逆转组蛋白乙酰化来关闭多种激活的炎症基因来抑制炎症。ICS通过抑制气道炎症降低气道高反应性，控制哮喘症状。ICS现在是所有持续性哮喘患者的一线治疗，控制哮喘症状并预防加重。吸入型长效β2受体激动剂加用ICS可进一步改善哮喘控制，通常作为复方吸入剂给药，可改善依从性，并在较低剂量皮质类固醇下控制哮喘。相比之下，ICS在COPD中提供的临床益处要少得多，并且炎症对皮质类固醇的作用具有抗性。这似乎是由于氧化应激导致HDAC2活性和表达降低。在重度COPD患者的支气管扩张剂中添加ICS，以减少急性加重。ICS从肺部吸收到体循环中，在大多数患者所需的剂量下具有可忽略的全身副作用，尽管用于COPD的高剂量具有一些全身副作用并增加发生肺炎的风险。
Inhaled corticosteroids (ICS) are the most effective controllers of asthma. They suppress inflammation mainly by switching off multiple activated inflammatory genes through reversing histone acetylation via the recruitment of histone deacetylase 2 (HDAC2). Through suppression of airway inflammation ICS reduce airway hyperresponsiveness and control asthma symptoms. ICS are now first-line therapy for all patients with persistent asthma, controlling asthma symptoms and preventing exacerbations. Inhaled long-acting β2-agonists added to ICS further improve asthma control and are commonly given as combination inhalers, which improve compliance and control asthma at lower doses of corticosteroids. By contrast, ICS provide much less clinical benefit in COPD and the inflammation is resistant to the action of corticosteroids. This appears to be due to a reduction in HDAC2 activity and expression as a result of oxidative stress. ICS are added to bronchodilators in patients with severe COPD to reduce exacerbations. ICS, which are absorbed from the lungs into the systemic circulation, have negligible systemic side effects at the doses most patients require, although the high doses used in COPD has some systemic side effects and increases the risk of developing pneumonia.