鼻腔类固醇喷剂、抗组织胺应用来控制气喘


  Nov. 3, 2005(蒙特娄)-- 于蒙特娄发表的研究显示,有效控制气喘应使用鼻腔类固醇喷剂(nasal steroids)和抗组织胺(histamine type 1 (H1) blockers),以减缓气喘中度至重度之症状,并降低气喘急性发作送急诊的机率。
  
  根据发表于胸腔医学期刊第71届美国胸腔科医师学会年会(American College of Chest Physicians,ACCP)上的一项回顾性、观察性研究,在2003年及2004年期间,323名难以治疗的实验组的患者,和12,070控制组的患者于社区中接受治疗相比较;资料是撷取自波多黎哥蓝盾保险公司所有服务和治疗的支出额,支付予两组实验对象,以积极疗法和控制来进行治疗。
  
  患者(年龄从12岁至70岁)有鼻窦炎的病史,鼻窦炎的症状为持续咳嗽、严重呼吸道阻塞(由肺活量计来测量),尖峰吐气流速值(peak flow readings)低;这些患者也曾有气喘急性发作被送进急诊室的经验,甚至严重到住院。
  
  在研究开始之后,患者被指导如何自己读取尖峰吐气流速值,如何使用鼻腔类固醇喷剂、吸入式气管治疗,以及紧急吸入式albuterol(支气管扩张剂);患者每天使用鼻腔类固醇喷剂,持续四周。
  
  波多黎哥圣胡安市气喘控制暨教育中心Ramon E. Figueroa-Lebron医师向Medscape表示,就诊患者有三分之一是因为慢性鼻窦炎,会进到肺的,必会先经过鼻子,气喘总是始于鼻窦炎,而咳嗽则是主要的症状,在影响到胸腔前,症状会在鼻窦区持续数周。
  
  不过,患者可能不知道,他们应该要每天测量尖峰吐气流速值数次,以观察呼吸道阻塞的状况;Lebron医师表示,就如同糖尿病患者要量血糖,是一样的道理。
  
  大多数的患者(93.2%)服用mometasone,而有6.8%的患者服用fluticasone(局部皮质类固醇);而就抗组织胺药物方面,有97.7的患者使用desloratadine,有3.2%的患者用loratadine(新型三环状长效型抗组织胺剂);Leukotriene modifiers(白三烯调节剂白三烯调节剂),montelukast(白三烯类受体拮抗剂)则分配予30%的患者服用。
  
  在2004年期间所治疗的176名患者中,有两名最后接受住院治疗;在2003年,服用气喘控制药物的患者中有一员,最后接受住院治疗;调查员估计,住院病患每减少一人次,代表著每年省下美金三元的经费,并注释控制组中住院的人数为每年1,937例。
  
  ACCP 主席W. Michael Alberts博士表示,研究强调尖峰吐气流速值降低可能是发生呼吸道阻塞的指标,若有客观的呼吸道阻塞测量,才能及早进行治疗。
  
  Alberts博士表示,很多时候,在症状发作前,早就有肺功能低下的状况发生;若测量结果呈现出来的是个数值,就可看出它是往下降的,那可能是疾病的征兆,若能及时以鼻用类固醇治疗,或是增加吸入式类固醇,或是气喘治疗,则可能预防症状的恶化。
  
  这项研究乃独立运作,研究者未接受任何经济援助。

Nasal Steroids, H1 Blockers Sh

By
Medscape Medical News

Nov. 3, 2005 (Montreal) — Research presented here suggests that asthma management should involve nasal steroids and histamine type 1 (H1) blockers to reduce moderate to severe asthma symptoms, as well as to reduce visits to the emergency department.

The retrospective, observational study, presented at CHEST 2005, the 71st annual meeting of the American College of Chest Physicians (ACCP), compared 323 patients who were refractory to treatment to 12,070 control subjects treated in the community in 2003 and 2004. The data were extracted from Blue Shield Puerto Rico expenditures of all services and medications paid for both subjects treated with the active therapies and controls.

The patients, aged 12 through 70 years, had rhinosinusitis characterized by persistent cough, severe airway obstruction as measured by spirometry, and low peak flow readings. They also had made prior visits to the emergency department and/or were admitted to the hospital.

After study enrollment, subjects were instructed on how to get a peak flow reading, the use of nasal steroids, inhaled bronchial medication, and emergency albuterol inhalations. Subjects took daily nasal steroids for four weeks.

"One third of all physician visits are due to chronic rhinosinusitis," Ramon E. Figueroa-Lebron, MD, a pulmonologist and director of the Asthma Management and Education Center in San Juan, Puerto Rico, told Medscape. "Everything that comes in the lung goes through the nose first. Asthma always starts with rhinosinusitus, and cough is the main symptom. The symptoms are in the sinus area for several weeks perhaps, before they travel to the chest."

Patients may not know that they should measure peak flow readings several times daily to determine the degree of airway obstruction, said Dr. Lebron. "It's the same way that diabetics need to be testing their blood sugar," he said.

The majority of patients (93.2%) received mometasone, and 6.8% of patients received fluticasone. In terms of H1 blockers, 97.7% received desloratadine, and 3.2% received loratadine. Leukotriene modifiers (montelukast) were administered to 30% of patients.

Of the 176 patients treated during 2004, two patients were admitted to the hospital. In 2003, one patient using asthma controllers was admitted to the hospital. The investigators estimated the reduction in hospital admissions to represent annual savings of $3, noting the number of admissions in the control population was 1,937 admissions per year.

The research highlights the fact that decreased peak flow readings should be seen as an indicator of possible airway obstruction, and that treatment can be initiated earlier if there is an objective measurement of airway obstruction, said W. Michael Alberts, president of the ACCP.

"A lot of times there may be a decrease in function before the symptoms appear," Dr. Alberts said. "If you had measured your peak flow with a number, you would see that it is moving downward. That may be an early warning sign that something is brewing. If you could intervene by initiating nasal corticosteroids or increased inhaled steroids or asthmatic medication, that might prevent worsening of symptoms."

The study was independently funded. The author disclosed no relevant financial relationships.

CHEST 2005: Poster 174. Presented Nov. 2, 2005.

Reviewed by Gary D. Vogin, MD

    
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