気管支喘息患者における長期吸入ステロイド療法の臨床効果および気道過敏性に対する影響 : 長期吸入ステロイド療法と気道過敏性 [in Japanese] EFFECT OF LONG-TERM TREATMENT WITH AN INHALED CORTICOSTEROID ON BRONCHIAL HYPER-RESPONSIVENESS AND CLINICAL ASTHMA IN ASTHMATIC SUBJECTS [in Japanese]
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当院通院中の成人気管支喘息患者のデータを解析し, 1年以上の吸入ステロイド療法の気道過敏性に対する効果, ならびにその臨床効果についてretrospectiveに検討した. 1) 年齢, BDP投与量, 使用期間, 罹病期間は平均で48.8歳, 801μg/day, 28.1力月, 9.2年であった. 2) 過敏性はBDP導入前後で平均で約6倍改善したが, 過敏性の改善しない症例も多く認めた. 3) 過敏性が4倍以上改善した症例を改善群(25例), それ以下の症例を非改善群(33例)として検討を行ったが両群間の臨床的背景, 導入後の%FEV_1については有意差は見られなかった. 4) near fatal asthmaの既往が非改善群において有意に高率であった. 5) 急性悪化回数は, 吸入ステロイド療法施行後, 有意に減少したが, 非改善群は改善群に比し, 救急受診, 入院回数とも有意に多かった. 以上より長期の吸入ステロイド療法後にても気道過敏性の改善しない症例が多く存在することが確認され, そのような症例では, 種々の刺激に対する喘息の悪化が高率に見られることがわかった.
We studied retrospectively the effect of long-term treatment with an inhaled corticosteroid on bronchial hyperresponsiveness (BHR) and clinical asthma in moderate-severe asthmatic subjects. Fifty-eight patients who had used beclomethasone dipropionate (BDP) over one year, were enrolled in this study. BHR was measured before and after treatment with BDP by the methods recommended by Japanese Socitey of Allergology. Moreover we examined the clinical factors and the frequency of acute exacerbations. The results as follows: 1) The mean age was 48.8 years and the mean asthma history was 9.2 years. The mean dose and mean time of BDP administration was 801 μg/day and 28.1 months, respectively. 2) Patients during BDP treatment over one year showed about 6-fold mean improvements in BHR, but there were many patients who showed no improvements in BHR. 3) We retrospectively divided all the patients into two groups. Namely, the improved group (n = 25) showed more than 4 fold improvement in BHR and unchanged group (n = 33), less than 4-fold. But there were no significant differences in clinical characteristics and %FEV_1 during treatment with BDP. 4) The unchanged group had more near fatal episodes in the past than the improved group. 5) There was significant decrease in acute exacerbation during treatment with BDP, but the unchanged group had more acute exacerbations than the improved group during treatment with BDP. These results indicates that there are many patients who had no improvement on BHR with long term BDP treatment and they have more acute exacerbations due to various stimuli. In conclusion, asthma is recognized chronic inflammatory disease and inhaled corticosteroid therapy has been recommended as the first line therapy. We must further study the clinical problems and underlying mechanisms concerning about treatment with an inhaled corticosteroid.
- Japanese Journal of Allergology
Japanese Journal of Allergology 45(12), 1231-1236, 1996
Japanese Society of Allergology