| Asthma is a chronic inflammatory disorder of the airway. The goal of asthma therapy is to achieve disease control. Although inhaled corticosteroids (ICS ) are the most effecive drugs for asthma treatment, there are still parts of patients who can't achieve asthma control by treatment with certain dose of ICS .Therefore, increased dose of ICS or other 'second treatment drug' such as long acting β 2 agonist(LABA) should be introduced. This study was performed to compare the role of treatment with ICS alone and combination with ICS and LABA in asthma control, airway inflammation and security in order to explore the way to gain optimal asthma control. At the same time, the efficacy of treatment with ICS alone and combination with ICS and LABA in severe persistent asthma was compared. Finally, the role of different virables in asthma control measurement was analysed and evaluated. Methods:1. A double blind, randomised, step-up comparison study was performed in 27 patients with asthma. The patients were assigned to treatment with either inhaled fluticasone propionate(FP) alone (n=14)(FP group) or combination of FP and salmeterol (n=13) (combination group) twice daily for 12 weeks(phaseI). If the subjects did not achieve total-controll during the phase I treatment period, the dosage of FP would be stepped up(doubled) for another 12 weeks treatment (phase II). Otherwise, the dosage would stay unchanged in phase II treatment period.2. A randomised, opened study was performed in 51 patients with severe persistent asthma . The patients were assigned to treatment with either inhaled FP 250mcg (n=26) or combination of FP and salmeterol 250/50mcg (n=27) twice daily for 6 weeks.3. We retrospectively analysed data of 68 subjects from two completed?ii ?clinical trials in our department to evaluate the efficacy of FP and combination of FP and salmeterol in moderate-severe asthma respectively during 1999-2000. The improvement percentage from baseline of each variable was calculated and the correlation between improvement percentage from baseline of each variable was analysed.Results:1. results of the first part:(1) During the two treatment phases, the proportion of patients who achieved well-controlled and total-controlled asthma and the improvement percentage of days with no symptoms in combination group is higher than that in FP group (p<0.01). Both groups had similar asthma exacerbations during the two treatment phases (p<0. 05).(2) Compared with baseline, no significant difference were observed for times of wake during night caused by asthma, morning PEF, FEV1 and FVC in FP group during treatment phase I (p>0. 05). During treatment phase II, all clinical outcomes improved markedly in FP group. During treatment phase I, all clinical outcomes improved markedly in combination group and improvements continued during treatment phase II. Improvements of all clinical outcomes in combination croup were greater than those in FP group.(3) During the two treatment phases, no significant difference in FP group was observed for the asthma quality of life questionnaire (AQLQ) grades including activity limitation, symptoms, emotional function (p>0. 05). While the grade of environment exposure and overall quality of life increased mildly during treatment phase II (p<0. 05). During treatment phase I, the grades of each domain and overall quality of life of AQLQ improved markedly in combination group, and the improvements continued during treatment phase II. All improvements were greater than those in FP group.(4) Compared with baseline, no significant change was observed in both groups for eosinophils(EOS) cells counts, expression of IL-5 and IL-4 in induced sputum during treatment phase I (p>0. 05). While all of these?in ?decreased markedly in both groups during treatment phase II (p<0. 05) , no significant difference between FP group and combination group was observed (p>0. 05).(5) At the end of treatment phase II,...
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