老年患者哮喘长期控制不佳应用雾化吸入糖皮质激素的疗效

Effect of nebulized corticosteroids on long-term poorly controlled asthma in elderly patients

目的评价长期雾化吸入糖皮质激素及支气管扩张剂治疗对长期控制不佳老年哮喘患者的疗效及安全性。方法采用前瞻性、随机对照的研究方法。将63例规律吸入激素或加用其他哮喘长期控制药物治疗3个月以上但仍处于哮喘中度或重度持续的老年哮喘患者，随机分为雾化吸入治疗组（31例）和常规吸入治疗组（32例）。分别采用布地奈德混悬液1mg及沙丁胺醇溶液2．5mg雾化吸入布地奈德／福莫特罗干粉吸入剂进行治疗。观察两组患者在治疗12周后肺功能、哮喘急性发作、哮喘控制测试（ACT）评分以及不良反应之间的差异。结果在试验结束时雾化吸入治疗组在清晨测定呼气峰流速（PEF）改善绝对值为（29．2±14．4）ml，优于常规吸入治疗组的（15．8±13．5）ml（t=3．715，P=0．000），雾化组ACT评分改善为（4．8±2．2）分，亦高于常规组的（3．0±2．7）分（t=2．897，P=0．005）。而两组在日均缓解药物使用次数及严重急性发作次数间均差异无统计学意义（t=-1．512，P=0．136；χ2=2．238，P=0．135）。吸入激素引起的局部不良反应上两组亦差异无统计学意义。结论与干粉吸入剂相比，采用雾化吸入的给药方式规律吸入糖皮质激素及支气管扩张剂，能更好地改善病情严重的高龄老年哮喘患者的临床症状及肺功能水平。同时该方法在为期12周的连续治疗中显示出了良好的安全性。

Objective To evaluate the efficacy and safety of long-term nebulized corticosteroids and inhaled bronchodilators therapy on asthma in long term poor controlled elderly patients. Methods Prospective, randomized control study was conducted. 63 elderly asthma patients, who received inhaled corticosteroids or combined with other long-term medication treatment for asthma control for more than 3 months but were still in moderate to severe persistent asthma state, were randomly divided into nebulizer treatment group （n= 31） and dry powder inhalation group （n= 32）, and they were treated correspondingly with Budesonide inhalation suspension 1 mg and Salbutamol 2.5 mg BidorBudesonide/Formoterol powder 320/9 μg inhalation Bid. Patients in the two groups were evaluated for the differences in lung function, acute exacerbations of asthma, asthma control test （ACT） and adverse effects after 12-week treatment. Results The improvement in morning peak expiratory flow （PEF） and ACT score were better in the test group than in the control group [（29.2 ±14.4） ml vg （15.8±13.5） ml, （4.8±2.2） w （3.0±2.7）, t=3.715 and 2. 897, P=0.000 and 0. 005], but there were no statistical differences in average daily use of relievers and severe acute exacerbations between the test and control groups （t=- 512, P=0. 136;χ2 =2. 238, P=0. 135）. The local adverse effects caused by inhaled corticosteroids had no significant difference between the two groups. Conclusions Compared with the powder inhalation, the nebulizer inhalation administration of corticosteroids and bronchodilators could improve the asthma symptoms and lung function better in elderly patients with serious asthma condition and shows a good safety in thel2 weeks of continuous treatment.