目的：了解完全控制哮喘患者的用药情况,并探讨不同用药情况对哮喘急性发作的影响。方法选取2007年1月—2013年12月在武汉大学人民医院呼吸内科门诊就诊或治疗后出院的501例完全控制哮喘患者为研究对象。根据用药情况,以单纯采用吸入药物进行治疗的患者为吸入治疗组,以联合采用口服药物和吸入药物进行治疗的患者为联合治疗组。入组后两组患者均维持达到完全控制时的治疗方案,随访24周。记录患者随访期间的临床表现、哮喘控制测试量表( ACT)得分、肺功能以及因哮喘急性发作退出试验的病例数、存在1次及以上急性发作的病例数、累计急性发作次数。结果共有371例患者按要求完成了24周随访,吸入治疗组和联合治疗组分别为208例(占56．1%)和163例(占43．9%)。两组完成24周随访患者的性别、平均年龄、第1秒用力呼气容积( FEV1)占预计值百分比、第1秒用力呼气容积占用力肺活量百分比( FEV1/FVC)及FEV1改善率比较,差异均无统计学意义( P>0．05)；而25%~75%用力肺活量时呼吸流速(FEF25%~75%)占预计值百分比比较,差异有统计学意义(P<0．05)。163例联合采用口服药物和吸入药物进行治疗的患者中,131例(占80．4%)的口服药物为茶碱缓释片,124例(占76．1%)为吸入大剂量糖皮质激素未获得完全控制者。吸入治疗组和联合治疗组因哮喘急性发作退出试验的病例数比较,差异有统计学意义(P<0．05)；完成24周随访的患者中,急性发作次数≥1次的病例数比较,差异有统计学意义(P<0．05)；累计急性发作次数比较,差异亦有统计学意义(P<0．05)。结论吸入药物疗法仍然是目前控制哮喘的主要治疗方法,对于单纯采用吸入疗法无法达到完全控制的患者,可适当联合采用口服药物进行治疗,茶碱缓释片是目前常用的口服治疗哮喘药物。与单纯采用吸入药物进行治疗的患者相比,联合采用口服药物和吸入药物进行治疗的患者哮喘急性发作水平较低。%Objective To investigate the medication of patients with totally controlled asthma, and explore the effects of different medications on acute episoded asthma. Methods We enrolled 501 patients with totally controlled asthma who received treatment in or discharged from the Department of Respiratory Medicine of Renmin Hospital of Wuhan University from January 2007 to December 2013. According to medication, the patients who were purely administrated with inhaled drugs were assigned into inhalation therapy group, and the patients who were administrated with both oral drugs and inhaled drugs were assigned into combined group. The two groups were given the same therapies when complete control was achieved. During the follow-up for 24 weeks, we recorded clinical manifestations, ACT score, pulmonary function, the number of cases who quitted the study due to acute episoded asthma, the number of cases with one or more than one times of acute episode asthma and the number of times of acute attack. Results A total of 371 patients completed 24 weeks of follow-up as required, with 208 (56. 1%) for inhalation therapy group and 163 ( 43. 9%) for combined group. The two groups were not significantly different ( P >0. 05 ) in gender, average age, the ratio of FEV1 to the predicted value, FEV1/FVC and the improvement rate of FEV1 of the patients who completed the 24 weeks′follow-up; the two groups were not significantly different in the ratio of FEF25% ~75% to predicted value ( P<0. 05) . Among the 163 patients who were administrated with both oral drugs and inhaled drugs, 131 (80. 4%) were orally administrated with theo - dur, and 124 ( 76. 1%) patients inhaled high - dose glucocorticoids but were not completely controlled. The two groups were significantly different ( P <0. 05 ) in the number of patients who quitted study due to acute episoded asthma, the number of patients who had times of acute episoded asthma≥1 and the accumulated number of times of acute episode among the patients who completed 24 weeks of follow -up. Conclusion Inhalation therapy is still the primary therapy for the asthma control. For patients who are only administrated with inhalation therapy but cannot be completely controlled, the combined use of oral drugs could be considered. Theo-dur is the common oral medication for asthma treatment. Compared with the patients who only take inhaled drug, the patients who take both oral drugs and inhaled drugs have low level in acute episoded asthma.
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