Doubling the dose of budesonide versus maintenance treatment in asthma exacerbations
Doubling the dose of budesonide versus maintenance treatment in asthma exacerbations
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DOI：
10.1136/thx.2003.014936
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发表时间：
2004-07-01
期刊：
影响因子：
10
通讯作者：
Lee, J
中科院分区：
文献类型：
--
作者：
FitzGerald, JM;Becker, A;Lee, J
背景资料：以前的指南建议加倍每日剂量的维持吸入皮质类固醇治疗或预防哮喘恶化的进展。方法：在6个月的时间内，对一组患者进行前瞻性评估，并在双盲对照试验中随机分配至继续维持剂量（MD）的吸入皮质类固醇或在恶化时加倍剂量（DD）治疗。共有290例患者接受了随机化（33%为男性），98例（DD，n = 46）在研究期间发生了可评价的哮喘急性发作。两组随机化时的平均（SD）基线特征（年龄33.5（14.0）岁; 1秒用力呼气量（FEV 1）2.8（0.7）I;呼气峰流速（PEF）422.9（110.5）I/min）相似。在DD组中，41%的患者被认为是治疗失败，因为他们需要全身性类固醇（n = 12），有一个计划外的医生访视（n = 1），或他们的哮喘没有恢复到基线（n = 6）。这与MD组没有差异，MD组40%治疗失败（n = 9，0和12，分别为; p = 0.94）。结论：在定期吸入皮质类固醇的患者中，维持剂量加倍可能不会影响恶化的模式。
Background: Previous guidelines recommend doubling the daily dose of maintenance inhaled corticosteroid to treat or prevent progression of exacerbations of asthma.Methods: Over a 6 month period a cohort of patients were evaluated prospectively and randomised in a double blind controlled trial to treatment with either a continued maintenance dose ( MD) of inhaled corticosteroid or doubling the dose ( DD) at the time of an exacerbation.Results: A total of 290 patients were randomised (33% male) and 98 (DD, n = 46) experienced evaluable asthma exacerbations during the study period. Mean (SD) baseline characteristics at randomisation ( age 33.5 (14.0) years; forced expiratory volume in 1 second (FEV1) 2.8 (0.7) I; peak expiratory flow (PEF) 422.9 (110.5) I/min) were similar in both groups. In the DD group 41% of patients were considered treatment failures because they either required systemic steroids ( n = 12), had an unscheduled visit to a physician ( n = 1), or their asthma did not return to baseline ( n = 6). This did not differ from the MD group in which 40% were treatment failures ( n = 9, 0, and 12, respectively; p = 0.94).Conclusions: In patients who regularly take an inhaled corticosteroid, doubling the maintenance dose may not affect the pattern of the exacerbation.