천식환자에서 흡입 스테로이드제 치료에 대한 반응에 미치는 인자
Factors Influencing the Responsiveness to Inhaled Glucocorticoids of Patients with Moderate to Severe Asthma
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Abstract
Background: Inhaled glucocorticoids (GC) are the most effective control therapy for asthma. Although the clinical effects of inhaled GC are different, there are little data on the differences in the individual responsiveness to inhaled GC. The purpose of this study was to identify those factors that are associated with responsiveness to high-dose inhaled GC in 86 adult patients with moderate to severe asthma. Method: Eighty-six patients with asthma who had initial FEV1% predicted values of less than 80% received inhaled GC (fluticasone propionate, 1,000μg/d) for four weeks. The primary end-points were FEV1, the ratio of FEV1 to forced vital capacity (FVC), the forced expiratory flow between 25% and 75% FVC (FEF 25～75%), and the score at presentation in the asthma-related quality-of-life questionnaire (AQLQ). Result: The inhalation of GC for four weeks had significantimprovements in the FEV1% predicted values and the AQLQ score, compared with the baseline values. Asthmatic patients with responses greater than 12% (n=46, 53.4%) in the change in FEV1 [ΔFEV1=(FEV1 at four weeks-baseline FEV1)/ baseline FEV1×100] also had significantly higher blood eosinophils and lower FEV1 (L) values prior to treatment. The ΔFEV1 values correlated with the number of sputum eosinophils prior to GC inhalation (r=0.242, P＜.05), and correlated inversely with the FEV1% predicted prior to GC inhalation (r=-0.462, P＜.001). Conclusion: The FEV1% predicted and the blood and sputum eosinophil levels prior to GC inhalation are associated with responsiveness to inhaled GC in patients with moderate to severe asthma.
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