哮喘降级治疗的证据与实践重庆--培训课件.ppt

Response to mannitol and percentage sputum eosinophils were significantly greater before a failed ICS reduction than before the last successful ICS reduction, whereas there were no significant differences in symptoms, spirometry, or eNO * * * Figure 4 Change from baseline in morning peak expiratory flow for patients who received montelukast 10 mg once daily t budesonide 400 mg twice daily or budesonide 800 mg twice daily. (A) All patients, (B) patients with asthma and concomitant allergic rhinitis, (C) patients with concomitant rhinitis requiring regular treatment. From Price et al.53 Adapted with permission from Wiley-Blackwell. * * * Key Point Smoking in individuals with asthma is associated with a decreased response to corticosteroids. Between January 2002 and February 2004, Lazarus et al conducted a multicenter, placebo controlled, randomized, double-blind, double-dummy, crossover trial to evaluate the response to inhaled corticosteroids and leukotriene receptor antagonists in individuals with asthma who smoke. The inclusion criteria for participants (44 nonsmokers and 39 light smokers aged 18 to 50 years old) consisted of prebronchodilator FEV1 values of 70% to 90% of predicted and heightened airway reactivity defined by 12% or greater reversibility after albuterol inhalation or by PC20 Mch ?8 mg/mL. Nonsmokers were defined as individuals who had not smoked for at least a year and who had a lifetime smoking history of less than 2 pack/years. Smokers were defined as individuals who smoked 10 to 40 cigarettes a day, had a 2 to 15 pack/year smoking history, and a diffusing capacity of carbon monoxide (DLCO) of ??80%. Individuals older than 50 years of age, who smoked more than 15 pack/years, smoked more than 40 cigarettes/day, and had a DLCO ?80% of predicted were excluded to avoid including patients with COPD. Subjects underwent two 8-week treatment periods. Subjects either received inhaled beclomethasone HFA or oral montelukast for 8 weeks and then underwent a