Effect of inhaled corticosteroids on small airways in asthma: Investigation using impulse oscillometry
Effect of inhaled corticosteroids on small airways in asthma: Investigation using impulse oscillometry
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DOI：
10.1016/j.pupt.2009.01.005
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发表时间：
2009-08-01
影响因子：
3.2
通讯作者：
Mishima, Michiaki
中科院分区：
文献类型：
--
作者：
Yamaguchi, Masafumi;Niimi, Akio;Mishima, Michiaki
背景：小气道似乎在哮喘中起着重要作用。氢氟烷-134a 丙酸倍氯米松 (HFA-BDP) 具有超细颗粒，因此比氯氟烃 (CFC)-BDP 在小气道中沉积更多。脉冲振荡测量系统 (IOS) 是一种新型无创肺功能测量方法，可以分别检查总气道 (R5)、大气道 (R20) 和小气道 (R5-R20) 的阻力以及低频电抗面积 (AX)，也被认为是小气道功能障碍的衡量标准。 方法：首次吸入皮质类固醇的轻度至中度哮喘患者被随机接受 200 mcg HFA-BDP bid（n = 26）或 400 mcg CFC-BDP bid（n = 12），以开放标签方式接受 12 周。基线测量后，每 4 周重复一次 IOS 和肺活量测定，并在 12 周时进行乙酰甲胆碱激发，以分别评估气道敏感性、气道反应性和肺容量。结果：R5-R20 或 AX 与肺活量测定和小气道肺容量指数之间以及 R20 与基线呼气流量峰值之间存在中度相关性。两组的基线临床或功能参数没有显着差异。第 12 周时，HFA-BDP 组的所有 IOS 指数均有所改善，而 CFC-BDP 组中除 R5-R20 之外的所有指数均有所改善。 R5-R20 和 AX 通过 HFA-BDP 逐步改进；与 CFC-BDP 组相比，这些变化在 12 周时达到了统计学显着性。其他 IOS 和肺活量测定指数未能显示出这种趋势。 HFA-BDP 显着减弱乙酰甲胆碱气道敏感性；这种衰减的程度与 R5-R20 和 AX 基线值以及治疗后 AX 的改善密切相关。结论：HFA-BDP 是治疗哮喘小气道的有效方法。长期治疗会随着时间的推移提供渐进的效果，这与气道反应性的减弱有关。 (C) 2009 Elsevier Ltd. 保留所有权利。
Background: Small airways appear to have an important role in asthma. Hydrofluoroalkane-134a beclomethasone dipropionate (HFA-BDP) has ultrafine particles and accordingly greater deposition in the small airways than chlorofluorocarbon (CFC)-BDP Impulse oscillometry systems (IOS), a new and non-invasive measure of pulmonary function, can examine the resistance of total (R5), large (R20), and small airways (R5-R20) separately, and low-frequency reactance area (AX), also considered a measure of small airways dysfunction.Methods: Mild-to-moderate asthmatics who were inhaled corticosteroid naive were randomized to receive 200 mcg HFA-BDP bid (n = 26) or 400 mcg CFC-BDP bid (n = 12) for 12 weeks in an open-label manner. Following baseline measurements, IOS and spirometry were repeated every 4 weeks, and methacholine challenge to separately assess airway sensitivity and airway reactivity and lung volumes at 12 weeks.Results: Moderate correlations were found between R5-R20 or AX and spirometry and lung volume indices of small airways, and between R20 and peak expiratory flow at baseline. The two groups did not significantly differ in baseline clinical or functional parameters. At 12 weeks, all IOS indices improved in the HFA-BDP group, whereas all but R5-R20 improved with CFC-BDP. R5-R20 and AX progressively improved with HFA-BDP; these changes achieved statistical significance at 12 weeks versus the CFC-BDP group. Other IOS and spirometry indices failed to show such trends. HFA-BDP significantly attenuated methacholine airway sensitivity; the degree of this attenuation strongly correlated with R5-R20 and AX baseline values, and with improvement of AX with treatment.Conclusion: HFA-BDP is an effective treatment of small airways in asthma. Prolonged treatment provides a progressive effect over time, which is associated with an attenuation of airway responsiveness. (C) 2009 Elsevier Ltd. All rights reserved.