目的 探討吸煙對支氣管哮喘患者臨床癥狀、肺功能及對吸入性糖皮質(zhì)激素( ICS) 治療反應(yīng)性的影響。方法 選取2008 年3 月至2009 年1 月門診就診的38 例慢性持續(xù)期哮喘患者, 根據(jù)是否吸煙分為吸煙組( 15 例) 和非吸煙組( 23 例) 。所有患者予以布地奈德吸入治療, 必要時(shí)可吸入β2 受體激動劑。發(fā)放哮喘日記卡及峰流速儀。記錄治療前及治療28 d 后哮喘癥狀評分、哮喘控制測試( ACT) 評分、肺功能、晨間及夜間峰流速( PEF) 。結(jié)果 兩組患者治療前除性別構(gòu)成外, 年齡、病程、ACT 評分、肺功能指標(biāo)差異均無統(tǒng)計(jì)學(xué)意義( P gt; 0. 05) 。兩組患者治療后ACT 評分、FEV1% pred、PEF% pred、FEV1 /FVC、晨間及夜間PEF 指標(biāo)均較治療前明顯改善, 哮喘癥狀評分顯著降低( P lt;0. 05) 。其中非吸煙組以上指標(biāo)的改善程度均優(yōu)于吸煙組( P lt;0. 05) 。結(jié)論 吸煙降低了哮喘患者對ICS 的治療反應(yīng)性。對吸煙的哮喘患者, 治療可能需要特殊的調(diào)整。
引用本文： 張莉 ,杜永成,許建英,楊麗莉. 吸煙對支氣管哮喘患者吸入糖皮質(zhì)激素治療反應(yīng)性的影響. 中國呼吸與危重監(jiān)護(hù)雜志, 2010, 9(4): 365-368. doi: 復(fù)制
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| 12. | Maestrelli P, Saetta M, Mapp CE, et al. Remodeling in response to infection and injury. Airway inflammation and hypersecretion of mucus in smoking subjects with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2001, 164: S76-S80. |
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- 1. Precht DH, Keiding L, Madsen M. Smoking patterns among adolescents with asthma attending upper secondary schools: a community-based study. Pediatrics, 2003, 111 : e562-e568 .
- 2. Chalmers GW, MacLeod KJ, Thomson L, et al. Smoking and airway inflammation in patients with mild asthma. Chest, 2001, 120: 1971 -1922.
- 3. 中華醫(yī)學(xué)會呼吸病學(xué)分會哮喘學(xué)組. 支氣管哮喘防治指南. 中華結(jié)核和呼吸雜志, 2008, 31: 177-185 .
- 4. 何權(quán)瀛, 高瑩慧. 關(guān)于吸煙問題若干名詞定義. 中華結(jié)核和呼吸雜志, 2009 , 32: 26.
- 5. 王曾禮, 馮玉麟, 主編. 呼吸病診療手冊. 北京: 人民衛(wèi)生出版社, 2000, 101-102.
- 6. Piccillo G, Caponnetto P, Barton S, et al. Changes in airway hyperresponsiveness following smoking cessation: comparisons between Mch and AMP. Respir Med, 2008, 102 : 2561 -2565 .
- 7. Polose R, Knoke JD, Russo C, et al. Cigarette smoking is associated with a greater risk of incident asthma in allergic rhinitis. J Allergy Clin lmmunol, 2008, 121: 1428 -1434 .
- 8. Chaudhuri R, Livingston E, McMahon AD, et al. Cigarette smoking impairs the therapeutic response to oral corticosteroids in chronic asthma. Am J Respir Crit Care Med, 2003, 168 : 1308 -1311 .
- 9. Churg A, Dai J, Tai H, et al. Tumor necrosis facter-α is central to acute cigarette smoke-induced inflammation and connective tissue breakdown. Am J Respir Crit Care Med, 2002, 166: 849-854.
- 10. Webster JC, Oakley RH, Jewell CM, et al. Pro-inflammation cytokines regulate human glucocorticoid receptor gene expression and lead to the accumulation of the dominant negative bisoform: a mechanism for the generation of glucocorticoid resistance. Proc Natl Acad Sci USA, 2001, 98: 6865-6870.
- 11. Ito K, Caramori G, Lim S, et al. Expression and activity of histone deacetylases in human asthmatic airways. Am J Respir Crit Care Med, 2002, 166: 392-396.
- 12. Maestrelli P, Saetta M, Mapp CE, et al. Remodeling in response to infection and injury. Airway inflammation and hypersecretion of mucus in smoking subjects with chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 2001, 164: S76-S80.
- 13. Chalmers GW, MacLeod KJ, Little SA, et al. Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma. Thorax,2002, 57: 226-230 .