吸烟对支气管哮喘患者吸入糖皮质激素治疗的影响

Influence of cigarette smoking on inhaled corticosteroid treatment in asthma patients

目的探讨吸烟对支气管哮喘(简称哮喘)患者临床症状、肺功能及气道炎症的影响,以及对激素治疗的敏感性。方法选取2009年12月至2011年1月门诊就诊的40例慢性持续期哮喘患者,根据是否吸烟分为吸烟组(15例)和非吸烟组(23例)。所有患者给予糖皮质激素(布地奈德)吸入治疗,必要时可吸入β2受体激动剂。发放哮喘日记卡及峰流速仪。记录治疗前及治疗28d后哮喘症状评分、哮喘控制测试(ACT)评分、肺功能、晨间及夜间最高呼气流速(PEF),诱导痰中嗜酸粒细胞及中性粒细胞百分比,并测定痰液中白介素8(IL-8)及嗜酸粒细胞趋化因子(eotaxin)水平。结果两组患者治疗前除性别构成外,年龄、病程、ACT评分、肺功能指标差异均无统计学意义。两组患者治疗后ACT评分(F=39.991,P<0.05)、FEV1%pred(F=56.075,P<0.05)、PEF%pred(F=53.535,P<0.05),嗜酸粒细胞百分比(F=15.271,P<0.05)及eotaxin(F=24.172,P<0.05)水平均较治疗前有明显改善,哮喘症状评分显著降低(P<0.05)。其中非吸烟组以上指标的改善程度均优于吸烟组(P<0.05)。结论吸烟降低了哮喘患者对ICS治疗的反应性。对吸烟的哮喘患者,治疗可能需要特殊调整。

Objective In this study,we investigate the impact of cigarette smoking on airway inflammation and the effect on responses to treatment with inhaled corticosteroids (ICS) in patients with bronchial asthma (asthma).Methods 38 outpatients with chronic stable asthma who visited from December 2009 to January 2011 were enrolled in the study. 23 cases were nonsmokers and 15 cases were smokers.All of them were treated by daily inhaled budesonide,and β2 agonist when necessary. They were required to record symptoms and peak expiratory flow every day on an asthmatic diary card. The patients were followed 28 days,ACT score,asthma-symptom score,asthma control test (ACT) score,pulmonary function,and peak expiratory flow were compared between non-smoking and smoking asthmatic patients. Induced sputum eosinophil and neutrophil proportion, and examined the levels of interleukin-8 (IL-8) and eotaxin in induced-sputum by enzymatic immunoassay (ELISA).Results All of the patients had statistically significant increases in ACT score (F=39.991,P<0.05),mean morning and night PEF,FEV1%pred (F=56.075,P<0.05),PEF%pred (F=53.535,P<0.05),eosinophil proportion (F=15.271,P<0.05) and eotaxin (F=24.172,P<0.05), and a significant decrease in asthma-symptom score after budesonide treatment compared with before. While there were significantly greater changes in any of these parameters in non-smokers than in smokers (P<0.05).Conclusions Active cigarette smoking impairs the efficacy of short term inhaled corticosteroid treatment in asthma. This finding has important implications for the management of patients with asthma who smoke.