Sputum eosinophilia and short-term response to prednisolone in chronic obstructive pulmonary disease: a randomised controlled trial
Sputum eosinophilia and short-term response to prednisolone in chronic obstructive pulmonary disease: a randomised controlled trial
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DOI：
10.1016/s0140-6736(00)02872-5
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发表时间：
2000-10-28
期刊：
影响因子：
168.9
通讯作者：
Pavord, ID
中科院分区：
文献类型：
--
作者：
Brightling, CE;Monteiro, W;Pavord, ID
背景 一些慢性阻塞性肺疾病（COPD）患者对皮质类固醇治疗有反应。这些患者是否具有与其他慢性阻塞性肺病患者不同的气道病理学尚不清楚。我们测试了以下假设：对泼尼松龙的反应与嗜酸性粒细胞性气道炎症的存在有关。方法我们进行了一项随机、双盲、交叉试验。仅接受支气管扩张剂治疗的慢性阻塞性肺病患者被随机分配安慰剂和每日 30 毫克泼尼松龙治疗，持续 2 周，中间间隔 4 周的清除期。在每个治疗周期之前和之后，我们通过肺活量测定、症状评分、慢性呼吸道疾病问卷（CRQ）、增量穿梭步行试验和诱导痰来评估患者。通过意向治疗进行分析。结果招募了 83 名患者，其中 67 名被随机分组。泼尼松龙治疗后痰嗜酸性粒细胞几何平均数显着下降（从 2.4% 降至 0.4%；平均差异六倍 [95% CI 3.1-11.4]），但安慰剂治疗后则没有显着下降。其他痰细胞计数没有变化。与安慰剂相比，根据基线嗜酸性粒细胞计数分层为三分位数，使用泼尼松龙后，支气管扩张剂后 1 秒用力呼气量 (FEV1) 和 CRQ 总分从最低嗜酸性粒细胞三分位数逐渐改善至最高。与安慰剂相比，使用泼尼松龙后支气管扩张剂 FEV1、总 CRQ 评分和穿梭步行距离的平均变化在最高三分位数中分别为 0.19 L (0.06-0.32)、0.62 (0.31-0.93) 和 20 m (5-35)。 COPD 和泼尼松龙的短期效应是由于炎症反应这一特征的改变所致。应调查痰嗜酸性粒细胞增多症确定对长期吸入皮质类固醇治疗特别有效的患者亚组的可能性。
Background Some patients wit chronic obstructive pulmonary disease (COPD) respond toe corticosteroid therapy. Whether these patients have different airway pathology from other COPD patients is unclear. We tested the hypothesis that response to prednisolone is related to the presence of eosinophilic airway inflammation.Methods We did a randomised, double-blind, crossover trial. Patients who had COPD treated with bronchodilators only were assigned placebo and 30 mg prednisolone daily for 2 weeks each, in a random order, separated by a 4-week washout period. Before and after each treatment period, we assessed patients with spirometry, symptom scores, the chronic respiratory disease questionnaire (CRQ), incremental shuttle walk test, and induced sputum. Analysis was done by intention to treat.Findings 83 patients were recruited, of whom 67 were randomised. The geometric mean sputum eosinophil count fell significantly after prednisolone (from 2.4% to 0.4%; mean difference six-fold [95% CI 3.1-11.4]) but not after placebo. Other sputum cell counts did not change. After stratification into tertiles by baseline eosinophil count, postbronchodilator forced expiratory volume in 1 s (FEV1) and total scores on the CRQ improved progressively after prednisolone from the lowest to the highest eosinophilic tertile, compared with placebo. The mean change in postbronchodilator FEV1, total CRQ score, and shuttle walk distance with prednisolone compared with placebo in the highest tertile was 0.19 L (0.06-0.32), 0.62 (0.31-0.93), and 20 m (5-35), respectively.Interpretation Our findings suggest that eosinophilic airway inflammation contributes to airflow obstruction and symptoms in some patients with COPD and that the short-term effects of prednisolone are due to modification of this feature of the inflammatory response. The possibility that sputum eosinophilia identifies a subgroup of patients who particularly respond to long-term treatment with inhaled corticosteroids should be investigated.