Inflammatory, Immunological and Clinical Comparisons of Short-and Long-acting Bronchodilators in Mild and Moderate Bronchial Asthma Patients

短效及長效支氣管擴張劑用在輕度及中度哮喘病患的炎性、免疫及臨床作用比較

趙崇良(Chung-Liang Chao):蔡富項(Fu-Shun Tsai) ； 李世偉(Shih-Wei Lee)

《中華民國急救加護醫學會雜誌》 10卷2期 (1999/06) Pp. 61-71

https://doi.org/10.30018/JECCM.199906.0003

摘要

有報導指出長效支氣管擴張劑會抑制局部及全身發炎及過敏反應，而短效支氣管擴張劑則會增加局部發炎反應但與全身性作用。長效支氣管擴張劑也被証實比短效支氣管擴張劑更有效果且更少副作用，但是也有相反的報導。我們做這實驗是要比較一種短效支氣管擴張劑terbutaline Sulfate及它的長效型bambuterol對全身性抗發炎及抗過敏效果、 臨床效應及副作用。二十位不抽菸且無使用類固醇藥史的病患參與此實臉。在實驗前三星期受創者除了吸入型短效支氣管擴張劑以外不用其他任何型式的支氣管擴張劑。然後他們由隨機交叉方式接受三星期的terbutaline Sulfate（2.5mg，一天三次）及三星期的bambuterol (l0mg，每晚）。在進入實驗期及每一種藥物使用結束時接受評估。實驗室評估包括肺功能、非特異性免疫球蛋白E 、五種抗原特異免疫球蛋白E、 C一反應蛋白、嗜酸性球鹼性蛋白、血中白血球總數、嗜中性球數及嗜酸性球數。臨床評估包括哮喘症狀總分、顫抖分數及藥物副作用總分。結果顯示兩種藥物都不會改善肺功能或對過敏反應有影響；但這兩種藥物，尤其bambuterol，會降低周邊白血球數；而只有bambuterol會對哮喘症狀有明顯的全盤改善。副作用在兩者都很少見，兩者間也沒有差別。

關鍵字

支氣管擴張劑 ； 哮喘 ； 抗炎性物質 ； 白血球數 ； 過敏原

並列摘要

Long-acting bronchodilators have been reported to have local and systemic inhibitory effects on inflammatory and allergic events while short-acting bronchodilators have been demonstrated to induce local but not systemic bronchial hyperreactivity. The long-acting bronchodilators also have been shown to have better efficacy and cause fewer adverse events compared with the short-acting forms. However, conflicting data are also presented. We conducted this study to compare the systemic anti-inflammatory and anti-allergic effects, clinical efficiency, and side effects of a short-acting bronchodilator (terbutaline sulfate) and its long-acting form (bambuterol), in mild and moderate bronchial asthma patients. Twenty nonsmokers with no history of steroid use were recruited. Participants were ref rained from using all forms of bronchodilators other than inhaled short-acting beta2-agonists for three weeks prior to beginning the study. They then received three weeks of terbutaline sulfate 2.5mg t.i.d. and three weeks of bambuterol 10mg h.s., in a randomized crossover fashion. Evaluations were performed at the end of the run-in and each drug administration period. Laboratory assessments included respiratory function, serum non-specific total immunoglobulin E(IgE), five antigen-specific IgEs, C-reactive protein, eosinophil cationic protein, blood total white cell count, neutrophil count, and eosinophil count. Clinical assessments included asthmatic symptom score, tremor score and drug side-effect score. The results showed neither drug significantly improved respiratory function or modulated allergic reactions; but both drugs, especially bambuterol, had significant inhibitory effects on the peripheral blood total white cell count, and bambuterol alone had better overall improvement in asthma symptoms. Side effects were seldom encountered and there was no significant difference between the drugs.

並列關鍵字

bronchodilator agents ； asthma ； anti-inflammatory agents ； leukocyte count ； allergens