Added Salmeterol versus Higher-Dose Inhaled Steroids in Symptomatic Asthma Patients Already Using Inhaled Steroids

氣喘病人在使用吸入型類固醇加salmeterol合併治療與單獨增加吸入型類固醇之比較

覃俊士(Chung-Shih Chin) ； 楊宗穎(Tsung-Ying Yang) ； 許正園(Jeng-Yuan Hsu)

《胸腔醫學》 18卷3期 (2003/06) Pp. 207-213

https://doi.org/10.29806/TM.200306.0003

摘要

吸入型類固醇目前為持續性氣喘的主要治療葯物。但是有許多病人在使用低劑量的吸入型類固醇後仍然會有症狀，在考量到只增加吸入型類固醇劑量可能會增加費用及副作用，但較果不一定顯著，加入其他種類的控制葯物如長效型beta-2受體的支氣管擴張劑（salmeterol）與吸入型類固醇合併使用會比只單純提高吸入型類固醇劑量較果更好、副作用更少。
在本實驗中，我們收入追蹤了60位持續性輕度到中度的氣喘病患。因為有症狀需使用吸入型類固醇（budesonide）每天1200ug八週後，將劑量減至每天 800ug且合併加入salmeterol使用八週，然後停止salmeterol且改回只使用 budesonide每天1200ug八週。實驗其間，我們比較病人的肺功能變化，症狀及短效支氣管擴張劑使用次數後發現。使用吸入型類固醇併salmeterol比單獨增加吸入型類固醇劑量時病人有較好的早晨，晚上的尖峰吐氣流速及第一秒的用力吐氣量。

關鍵字

氣喘 ； 吸入型類固醇 ； 長效型beta-2受體的支氣管擴張劑

並列摘要

Inhaled glucocorticoid is the main treatment for patients with persistent asthma. Due to the ceiling and side effects of inhaled steroids, the addition of another form of controller medication, rather than increasing the dose of the inhaled steroid, is suggested for these symptomatic patients.
We enrolled sixty patients with mild to moderate asthma, and who were symptomatic while using budesonide 1200mg daily. The dose of budesonide remained at 1200mg daily for 8 weeks, and then was reduced to 800mg daily with salmeterol added. Eight weeks later, the salmeterol was discontinued and the budesonide was increased to 1200mg daily again. We compared the pulmonary function parameters, symptom scores, frequency of bronchodilator use for first aid, and other factors in these two regimens.
The morning peak expiratory flow rate increased from 380.5 l/min to 398.7 l/min after adding salmeterol (p = 0.004), then decreased from 381.7 l/min to 371.0 l/min after discontinuing it (p = 0.014). The night peak expiratory flow rate showed the same trend, from 390.1 l/min to 409.3 l/min, after adding salmeterol (p ＜ 0.001), and from 395.7 l/min to 383.6 l/min after discontinuing it (p = 0.013). The forced expiratory volume in 1 second increased 140 ml/sec after adding salmeterol (p ＜ 0.001), and decreased 130 ml/sec after discontinuing it (p = 0.001).
The addition of salmeterol to the inhaled budesonide used by asthma patients who remained symptomatic showed a greater improvement in pulmonary function parameters than simply increasing the dose of inhaled budesonide.

並列關鍵字

salmeterol ； budesonide ； inhaled steroid ； long-acting beta-2 agonist