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曾认为大剂量吸入类固醇易使哮喘患者下丘脑-垂体-肾上腺(HPA)轴功能受损,但最近有报道,通过贮雾器吸入二丙酸氯地米松(BDP)患者HPA 轴功能正常。本研究试图回答①长期应用时,BDP 致HPA轴功能受损的日剂量;②有关贮雾器保护作用的开放研究,其结果能否被双盲、随机研究证实;③通过贮雾器大量吸入类固醇是否较常规雾化吸入更有效.研究对象50例,18～70岁,有慢性哮喘史:吸入支气管扩张剂12个月内FEV_1改善>15%;每日需吸入类固醇800μg 以上,FEV_1基础值高于20%预计值;且均可有效应用计量雾化器。方法与结果研究为随机、双盲、双哑、有类似组。患者接受为期4周的观察(BDP1.5mg/d),而后通过以下试验检测HPA 轴功能:上午9h 血清皮质醇
It has been suggested that high doses of inhaled steroids tend to impair the hypothalamic-pituitary-adrenal (HPA) axis in asthmatics, but it has recently been reported that HPA axis function is normal in inhaled beclomethasone dipropionate (BDP) through a vaporizer. This study sought to answer ① the daily dose of HPA axis impaired by BDP in long-term use; ② the open-label study on the protective effect of aerosol can be confirmed by double-blind, randomized studies; 50 cases of subjects, aged 18 to 70 years, with a history of chronic asthma: FEV_1 improved> 15% within 12 months of inhaled bronchodilator; daily inhaled steroid 800μg or more, FEV 1 basal value Higher than 20% of the expected value; and can effectively measure the atomizer. Methods and results of randomized, double-blind, dumb, have similar groups. Patients underwent a 4-week observation (BDP, 1.5 mg / d) and then tested for HPA axis function by the following test: 9h serum cortisol