Inhaled glucocorticoids decrease nitric oxide in exhaled air of asthmatic patients
Inhaled glucocorticoids decrease nitric oxide in exhaled air of asthmatic patients
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DOI：
10.1164/ajrccm.153.1.8542158
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发表时间：
1996-01-01
影响因子：
24.7
通讯作者：
Barnes, PJ
中科院分区：
文献类型：
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作者：
Kharitonov, SA;Yates, DH;Barnes, PJ
呼出的一氧化氮（NO）在未经治疗的哮喘患者中升高，但在吸入糖皮质激素治疗的患者中不升高。这可能反映了糖皮质激素对呼吸道中NO合酶诱导的抑制作用。我们在一项双盲交叉随机顺序安慰剂对照研究中，研究了吸入糖皮质激素（布地奈德800 μ g，每日两次，通过干粉递送系统，持续3周）对11例轻度哮喘患者呼出气NO的影响。治疗3周后，呼出的NO从基线值203 +/- 29 ppb降至120 +/- 26 ppb（p < 0.01），而匹配的安慰剂治疗后无变化（基线值169 +/- 20，3周后为184 +/- 16 ppb）。从1到3周，呼出的NO显著和进行性下降。吸入类固醇后，FEV（1）无显著变化（尽管基线时平均FEV（1）为92%预测正常值），尽管气道对乙酰甲胆碱的反应性降低（约2.5倍稀释）。这些结果进一步支持了这样的观点，即哮喘中呼出的NO水平升高可能来自于诱导型NO合酶亚型的诱导，并表明呼出的NO可能是监测糖皮质激素和其他抗炎治疗哮喘的抗炎作用的有用方法。
Exhaled nitric oxide (NO) is elevated in untreated patients with asthma but not in patients treated with inhaled glucocorticoids. This may reflect an inhibitory effect of glucocorticoids on the induction of the enzyme NO synthase in the respiratory tract. We have now studied the effect of an inhaled glucocorticoid (budesonide 800 mu g twice daily via a dry powder delivery system for 3 wk) on exhaled NO in 11 patients with mild asthma in a double-blind crossover randomized-order placebo-controlled study. Exhaled NO was reduced from a baseline value of 203 +/- 29 parts per billion (ppb) to 120 +/- 26 ppb after 3 wk of treatment (p < 0.01), whereas there was no change after a matched placebo (169 +/- 20 at baseline compared with 184 +/- 16 ppb after 3 wk). A significant and progressive fall in exhaled NO was found from 1 to 3 wk. There was no significant change in FEV(1) after inhaled steroids (although mean FEV(1) was 92% predicted normal at baseline), although there was a reduction in airway responsiveness to methacholine (approximately 2.5 doubling dilutions). These results add further support to the view that the elevated levels of exhaled NO in asthma may derive from induction of an inducible isoform of NO synthase and indicate that exhaled NO may be a useful way of monitoring the anti-inflammatory effects of glucocorticoids and other anti-inflammatory treatments in asthma.