Differentiation Sequential Treatment Of Patients With Steroid-dependent Asthma Effect And Mechanism Discussed

With the understanding of airway allergic inflammation in asthma, glucocorticoidinhalation has been the principal medicine with its positive therapeutic efficacy and a fewside effects. However, there are still many patients who have to depend on oral steroids tocontrol symptoms which will become worse when the dosage of oral steroids get smaller.This sort of asthma is defined as steroiddependentasthma (SDA) belonging to difficultasthma.We all know that antiimmune preparations are widely used for alternative of SDA, jetits therapeutic efficacy is not positive. On the other hand, these therapies are difficult toaccept for its side effects. Traditional Chinese medicine (TCM) put emphasis on holism andbalance of yin and yang. The herbs are superior to modern medicine owing to bettertreatment effect on SDA and almost with few side effects. The herbs treatment of SDA is justat the beginning of phase because most of data such as single case investigations are short ofsystematic clinic trials and randomized controlled method.Wu Weiping', my advisor tutor, argues that deficiency of yin and yang, stiring up ofdeficient wind, accumulation of phlegm and blood stasis in the body, simultaneousoccurrence of cold and heat syndrome are essential pathogenesis in the SDA after using theglucocorticoid as the leading treatment medication. She believes that the patients presentsuch pathologic change rules as from deficiency of yin and hyperactivity of evil fire beforethe steroid withdrawal to deficiency of yin and yang during the steroid withdrawal todeficiency of kidneyyangafter the steroid withdrawal, with the syndrome of the stasis ofsputum and blood throughout the whole process. Hereby she framed the sequential therapybased on syndrome differentiation that compose by ZhiBaiDiHuang pill(smoothing bronchialwheezing by nourishing yin), WuMei pill(supplementing both the vital energy and blood,regulating cold and heat) and JinKuiShenQi pill(smoothing bronchial wheezing bynourishing yang). This way can help to dismantle steroid and control asthma symptomsObjective and methods: In order to give the seal to this theory, this trail have shown thethreestepsequential therapy's effect on the SDA patients and on hypothalamicpituitaryadrenal(HPA) axis functions . The study population consisted of 80 patients randomized toreceive the threestepsequential therapy + Pulmicort Turbuhaler 200μg , Bid,who belongedto the treatment group or Pulmicort Turbuhaler 400μg , Bid,who belonged to the comparedgroup in a single blind, randomized controlled trial. In the first two weeks, the dosage ofsteroid had no change, and in the third week, the dosage of steroid became smaller accordingto the patients'peak expiratory flow rate and the score for asthma symptoms. During thesteroid withdrawal, the patients in the treatment group got the herbs treatment. After 12weeks observation, all the results was collected and statistical analyzedResults: It suggests that the pathologic change rule as from deficiency of yin andhyperactivity of evil fire before the steroid withdrawal to deficiency of yin and yang duringthe steroid withdrawal to deficiency of kidneyyangafter the steroid withdrawal existsthroughout the steroid withdrawal. Over the twelve weeks of treatments, the number ofpatients without deficiency of kidneyyangis 7 in treatment group, while the number is 2 incompared groups, The threestepsequential therapy could modify deficiency of kidney. The treatment group is significant superior to the compared group in the improvement of TCM'syndrome, HPA axis functions and in improvement of asthma quality of life, when it shownno significant differences in therapeutic effect on the times of using Ventolin and on the lungfunctions.Conclusion: The study indicate that threestepsequential therapy could decrease thedosage of oral steroid , improve the lung functions, reduce SDA patients'dependency onsteroid and upgrade asthma quality of life by recovering HPA axis functions and improvingthe number of glucocorticoids receptor on peripheral blood mononeuclear cell. Thesequential therapy based on syndrome differentiation could be provided as an effectivealternative of oral steroids with few side effects.