布地奈德福莫特罗粉吸入剂致流感样综合征

Drug-induced flu-like syndrome caused by budesonide and formoterol fumarate powder for inhalation

1例33岁男性患者因支气管哮喘给予布地奈德福莫特罗粉吸入剂治疗，每次1吸（每吸含布地奈德160μg、福莫特罗4.5μg），2次/d。6 d后患者出现发热（体温38.2℃）、头痛、鼻塞、流涕、打喷嚏等流感样症状，自行服用酚麻美敏（1片，3次/d）。2 d后患者体温恢复正常，头痛缓解。次日停用酚麻美敏，鼻塞、流涕等症状有减轻但持续存在。布地奈德福莫特罗粉吸入剂应用1个月后，患者因未及时复诊停用该药。停药第2天，鼻塞、流涕等流感样症状缓解；第3天，症状消失。间隔3 d后，患者再次应用该药，用药后约30 min流感样症状再现，体温达38.8℃。考虑为药源性流感样综合征，停用该药，改为沙美特罗替卡松粉吸入剂，并给予氯雷他定和对乙酰氨基酚口服。4周后复诊，患者未再出现流感样症状。

A-33-year-old man with bronchial asthma received budesonide and formoterol fumarate powder for inhalation one suction twice daily（ one suck containing budesonide 160 μg and formoterol 4. 5μg）. After 6 days of treatment,he developed the symptoms of fever（temperature of 38. 2 ℃）,headache, nasal obstruction,runny nose and sneeze. He took paracetamol,pseudoephedrine hydrochloride,dextrome-thorphan hydrobromide and chlorphenamine maleate one tablet thrice daily by himself. Two days later,the body temperature returned to normal and the headache was relieved. The follow day, paracetamol, pseudoephedrine hydrochloride,dextromethorphan hydrobromide and chlorphenamine maleate was stopped, the nasal obstruction and runny nose slightly better but continuous. The budesonide and formoterol fumarate powder for inhalation was discontinued after one month because of the patient absent re-visiting in time. The symptoms of nasal obstruction and runny nose were relieved in the second day and disappear in the third day. The patient was using the drug again at intervals of 3 days,the flu-like symptoms recurred in 30 minutes and the body temperature reached 38. 8 ℃. Drug-induced flu-like syndrome was considered. Budesonide and formoterol fumarate powder for inhalation was stopped and changed to salmeterol xinafoate and fluticasone propionate powder for inhalation. Loratadine and acetaminophen were given. The flu-like symptoms did not recur during four weeks of follow-up.