Yaşlı astımlılarda orta-doz flutikazon ve salmeterolün bronkokonstriksiyonun algılanmasına etkisi

Yıl 2005, Cilt: 12 Sayı: 4, 10 - 13, 16.04.2009

Aydanur Ekici Türkan Kara Ahmet Akın Pınar Koçyiğit Ali Karlıdağ Mehmet Ekici

Öz

SüleymanDemirel Üniversitesi
TIP FAKÜLTESİ DERGİSİ: 2005 Aralık; 12(4)



Yaşlı astımlılarda orta-doz flutikazon ve salmeterolün bronkokonstriksiyonun algılanmasına etkisi



Aydanur Ekici, Türkan Kara, Ahmet Akın,Pınar koçyiğit, Ali karlıdağ, Mehmet Ekici



Özet

Amaç: Orta-doz Flutikazon ve salmeterol tedavisinin bronkokonstriksiyonun algılanmasına etkisinin yaşlı ve genç astımlılarda değerlendirilmesi. Metot: Yirmidokuz yaşlı astımlı (•60 yaş) ve 21 genç astımlı (<60 yaş) hasta çalışmaya katıldı. Yaşlı astımlılar semptom sürelerine göre iki gruba ayrıldı (geç başlangıçlı astım< 5 yıl; erken başlangıçlı astım •5 yıl). Orta persistan astımlı 50 hasta bir yıl boyunca günde iki defa 250 ug flutikazon propionat ve 50ug salmeterol tedavisi aldı. Her hastaya başlangıçta ve bir yıl sonra histamin ile bronş provokasyon testi yapıldı. Nefes darlığı modifiye Borg skalası ile değerlendirildi. Birinci saniye zorlu vital kapasite'de (FEV1) %20'lik bir düşmenin olduğu Borg skoru Algılama skoru 20 (AS20) olarak saptandı.Sonuçlar: Geç başlangıçlı yaşlı astımlılarda başlangıç ortalama AS20 değerleri (1.21 ± 0.18) ile tedavi sonrası ortalama AS20 değerleri (1.32 ± 0.22) arasında anlamlı fark yoktu (p=0.7). Erken başlangıçlı yaşlı astımlılarda başlangıç ortalama AS20 değerleri ile (1.45 ± 0.14) tedavi sonrası ortalama AS20 değerleri (1.11 ± 0.30) arasında anlamlı fark yoktu (p=0.2). Genç astımlılarda başlangıç ortalama AS20 değerleri (2.27 ± 0.25) ile tedavi sonrası ortalama AS20 değerleri (2.07 ± 0.29) arasında anlamlı fark yoktu (p=0.3). Yaşlı astımlılarda başlangıç ortalama AS20 değerleri (1.31 ± 0.12; 2.27 ± 0.25 p=0.001) ve tedavi sonrası ortalama AS20 değerleri (1.23 0.18; 2.07 ± 0.29 p=0.01) genç astımlılardan düşüktü. Yorum:Çalışma orta doz flutikazon ve salmeterol tedavisinin yaşlı ve genç astımlılarda bronkokonstriksiyonun algılanmasını değiştirmediğini düşündürmektedir.Ancak yaşlı astımlıların başlangıçtaki ve bir yıl sonraki algılamaları genç astımlılardan daha düşük bulunmuştur.



Anahtar kelimeler: Astım, hava yolu daralması, Borg skalası,algılama, tedavi



Abstract



Effect on perception of bronchoconstriction of moderate-dose fluticason plus salmeterol in elderly asthmatics

We evaluate the effect of moderate-dose fluticasone plus salmeterol on perception of bronchoconstriction in elderly and in young asthmatics. Twenty-one young asthmatics (aged <60yrs) and 29 elderly asthmatics (•60 yrs ) were studied. The elderly asthmatics were separated into two groups according to the duration of symptoms (late-onset asthma <5 year, early-onset asthma •5 year). 50 patients with moderate asthma were assigned to a 1yr treatment with 250 ug of fluticason propionate plus 50ug salmetorol, twice daily.At entry and after 1 yr , histamine challenge test was performed for each patient. Dyspnea was assessed by modified Borg scale. The Borg score in FEV1 reduction by 20% was determined as perception score 20 (PS20). Results: There was no significant difference between mean PS20 values at entry (1.21 ± 0.18) and after the first year(1.32 ± 0.22) for late onset elderly asthmatics (p=0.7). There was no significant difference between mean PS20 values at entry (1.45 ± 0.14) and after the first year (1.11 ± 0.30) for early onset elderly asthmatics (p=0.2). There was no difference between mean PS20 values at entry (2.27 ± 0.25) and after the first year (2.07 ± 0.29) for young asthmatics (p=0.3). The mean PS20 value of elderly asthmatics at entry (1.31 ± 0.12, 2.27 ± 0.25 p=0001) and after the first year (1.23 ± 0.18, 2.07 ± 0.29 p=0.01) was lower than young asthmatics. Conclusion: Our study suggested that the treatment of moderate-dose fluticasone plus salmeterol did not change perception of bronchoconstriction in elderly asthmatics. Perception of elderly asthmatics at entry and after 1 yr was lower than young asthmatics.



Key words: asthma, bronchoconstriction, Borg scale, perception, treatment

Anahtar Kelimeler

Astým, hava yolu daralmasý, Borg skalasý, algýlama, tedavi

Kaynakça

• Spinhoven P, van Peski-Oosterbaan AS, Van der Does AJ, Willems LN, Sterk PJ. Association of anxiety with perception of histamine induced bronchoconstriction in patients with asthma. Thorax 1997 ;52 (2):149-52.
• Nguyen BP, Wilson SR, German DF. Patients' perceptions compared with objective ratings of asthma severity. Ann Allergy Asthma Immunol 1996 ;77 (3):209-15
• Bijl-Hofland ID, Cloosterman SG, van Schayck CP, v d Elshout FJ, Akkermans RP, Folgering HT. Perception of respiratory sensation assessed by means of histamine challenge and threshold loading tests. Chest 2000; 117(4):954-9.
• Jang AS, Choi IS Increased perception of dyspnea by inhalation of short acting beta2 agonist in patients with asthma of varying severity. Ann Allergy Asthma Immunol 2000 ;84(1):79-83.
• Zach MS, Karner U. Sudden death in asthma. Arch Dis Child 1989 ;64(10):1446-50.
• Salome CM, Reddel HK, Ware SI, Roberts AM, Jenkins CR, Marks GB ve ark. Effect of budesonide on the perception of induced airway narrowing in subjects with asthma. AmJ Respir Crit Care Med 2002 ; 165(1):15-21.
• American Thoracic Society. Standards for diagnosis and care of patients with chronic obstructive pulmonary diseases (COPD) and asthma. Am Rev Respir Dis 1987;136:225-244.
• Foresi A, Mattoli S, Corbo GM, Polidori G, Ciappi G. Comparison of bronchial response to ultrasonically nebulized distilled water, exercise and methacholine in asthma. Chest 1986;90:822–6.
• Boulet LP, Leblanc P , Turcotte H. Perception scoring of induced bronchoconstriction as an index of awareness of asthma symptoms. Chest 1994; 105: 1430-3 .
• Bijl-Hofland ID, Cloosterman SG, Folgering HT, van Den Elshout Fj, van weel C, van Schayck CP. Inhaled Corticosteroids, combined with Long-acting beta(2)- agonists, improve the perception of bronchoconstriction in Asthma. Am J Respir Crit Care Med 2001; 164 (5): 764-9.
• Weiner P, Berar-Yanay N, Davidovich A, Magadle R, Weiner M.The perception of dyspnoea in patients with asthma, before and following treatment with inhaled glucocorticosteroids. Respir Med 2000; 94 (2): 161- 5.
• Boulet LP, Turcotte H, Cartier A, Milot J, Cote J, Malo JL ve ark. Influence of beclomethasone and salmeterol on the perception of bronchoconstrication. Chest 1998; 114: 373-9.
• Roisman GL, Peiffer C, Lachronique JG, Le Cae A, Dusser DJ. Perception of bronchial obstruction in asthmatic patients: Relationship with bronchial eosinophilic inflammation and epithelial damage an effect of corticosteroid treatment. J Clin Invest 1995; 96: 12-21.
• Ottanelli R, Rosi E, Romagnoli I, Grazzini M, Stendardi L, Duranti R ve ark. Do inhaled corticosteroids affect perception of dyspnea during bronchoconstriction in asthma? Chest 2001; 120(3): 770-7.
• Higgs CM, Laszlo G. Influence of treatment with beclomethasone, cromoglycate and theophylline on perception of bronchoconstriction in patients with bronchial asthma. Clin Sci 1996; 90(3): 227-34.
• In’tVeen JC, Smits HH, Ravensberg AJ, Hiemstra PS, Sterk PJ, Bel EH. Impaired perception of dyspnea in patients with severe asthma. Relation to sputum eosinophils. Am J Respir Crit Care Med 1998; 158(4): 1134-41. 13