支气管哮喘吸入治疗与气道反应性关系的研究

A study of the relationship between airway responsivenss and ICS/LABA inhalation therapy for bronchical asthma

目的探讨气道反应性与支气管哮喘吸入治疗的关系。方法选择50例支气管哮喘患者作为研究对象,给予吸入沙美特罗氟替卡松50μg/250μg,每日1～2次,分别在治疗前、治疗后3、6、12个月进行常规肺功能检查和支气管激发试验,测定最大呼气流量(PEF)、1s用力呼气容积(FEV1)、最大呼气中段流量(MMEF)及比气道传导率下降35%或以上时吸入乙酰甲胆碱浓度(PC35sGaw)。结果治疗3个月后大部分患者的临床症状较治疗前有明显改善,PEF、FEV1明显上升,全部病例支气管激发试验仍为阳性;6个月后超过80%的患者哮喘完全控制、肺功能恢复正常,但激发试验阳性病例为38例,达76%;12个月后,超过90%的患者肺功能恢复正常,29例(58%)激发试验阳性。结论哮喘临床症状达到完全控制的时间早于气道反应性达到理想水平的时间,气道反应性指标在调整治疗方案中的价值优于临床症状和肺功能,是评估哮喘的严重程度、药物治疗疗效判断及停药的指标之一。

Objective To explore the relationship between airway responsiveness and bronchial asthma inhalation therapy.Methods Select 50 asthmatic patients as research subjects,Fluorine given inhaled salmeterol 50 mcg/fluticasone propionate 250 micrograms,1-2 times a day,Respectively before treatment,after treatment,3 months,6 months,12 months,conventional pulmonary function tests and bronchial provocation test,Determination of peak expiratory flow（PEF）,and a second forced expiratory volume（FEV1）,maximum mid-expiratory flow（MMEF） and specific airway conductance decreased 35% or above to inhaled methacholine the concentration（PC35sGaw）.Results Three months after the majority of patients with clinical symptoms before treatment,after treatment,significant improvement,PEF,FEV1 increased significantly in all cases of bronchial provocation test is still positive,six months after treatment,more than 80% of patients with asthma,complete control,lung function returned to normal follow-up provocation test positive cases of 38 cases,up to 76% after 12 months of treatment,more than 90% of patients with lung function returned to normal.29 cases（58%） stimulation test positive.Conclusion Asthma clinical indicators have reached complete control to achieve the desired level of time earlier than the airway responsiveness,airway responsiveness index value in the long-term follow-up of the combination therapy,and adjust the treatment plan is superior to clinical symptoms and lung function,is a serious assessment of asthmadegree of judgment and withdrawal of drug treatment of one of the indicators.