천식 용 Steroid 흡입 제….매일 흡입 할 필요 없다 > 임상 응용 정보

천식 용 Steroid 흡입 제….매일 흡입 할 필요 없다

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천식 용 Steroid 흡입 제….매일 흡입 할 필요 없다</TD></TR>
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경증 내지 중등도의 성인 천식 환자는 Steroid 흡입 제를 
매일 흡입 할 필요 없으며 증상이 나타날 때 만 
흡입하면 된다는 놀라운 사실이 밝혀졌다
 
이는 미국 보건 성 주최로 실시된 비교 입상 연구 결과이며
미국 Texas 의대를 비롯 15 개 의대 연구팀이
미국 의사 회 학술 지를 통해 발표한 내용이다
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증상 나타날 때 만 흡입 </TD></TR>
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지금 까지의 천식 치료 지침에 의하면 
경증 내지 중등도의 천식은 Steroid 흡입 제를 
하루 2회  매일 흡입 하도록 처방 되어 왔다 
 
증상이 있던 없던 없던 흡입 하는 것이다
 
만약 발작 증상이 나타나면 Salbutamol 같은 
기관지 확장 제를 즉시 흡입하여 가라 않치고  
Steroid 는 계속 시간 맞추어 흡입한다
 
그러나 증상 없는 상태에서 Steroid를 흡입 하는 것은 
아무런 이득이 없을 뿐 아니라
부작용만 가중 시킬 수 있다는 사실이 밝혀 진 것이다
 
이를 입증 하기 위해 342명의 성인 천식 환자를 대상으로
9개 월간을 비교 임상을 실시하였다 
 
하루 2회 매일 흡입 하는 경우 (PABA군)와 
증상 나타 날 때 마다 흡입하게 하는 경우(SABA군)를 
발작 빈도나 응급 입원 율 면에서 비교해 볼 때
아래 그림에서 처럼 전혀 차이가 없음이 밝혀 졌다 
 
<IMG src="/_dimg/3-1%20막대그림%20akeeormfl20141215_173351.png">
 [그림] 계절별 실패 율 (발작 빈도 및 응급 입원 수) 
   
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9 개월 간 실패 빈도 (발작 + 입원)</TD></TR>
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PABA군 (매일 2회 흡입하고 6주 1회씩 의사가 흡입량 조절)  </TD>
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24회 (22%)</TD></TR>
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BBA군 (호흡 능력을 정학히 측정하면서 흡입량을  조절 )</TD>
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21회(20%)</TD></TR>
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SABA군 (환자 임의로 증상 있을 때마다 흡입하는 군 )</TD>
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16회(15%)</TD></TR></TBODY></TABLE>
 
 
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호흡 기능 개선 정도도 차이 없다</TD></TR>
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Steroid 를 매일 두 번 씩 흡입 하는 경우(PAVBA)와
증상 나타날 때만 환자가 알아서 흡입 하는 경우의 
호흡 기능 개선 도를 비교 해 본  결과 아래 그림 처럼 차이가 전혀 없음이 나타났      
 
<IMG src="/_dimg/3-2%20그림%2020141215_173518.png">
[그림] 왼편: 호기( Fev1)능력  오른 편: 산화질소 배기력)
 
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호흡기 개선 도 </TD></TR>
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 </TD>
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Fev1</TD>
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산호 
질소</TD>
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타액
eosinophil</TD>
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IgE</TD>
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Salbutamol
응급사용</TD></TR>
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PABA군 
 </TD>
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9.6</TD>
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21.38</TD>
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0.40</TD>
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130</TD>
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0.04</TD></TR>
<TR >
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 69.2pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ffffff; BORDER-RIGHT: black 1pt solid; " width=92>
BBA군 
 </TD>
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9.6</TD>
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18.88</TD>
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0.20</TD>
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118.9</TD>
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0.07</TD></TR>
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SABA군 
 </TD>
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9.2</TD>
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20.78</TD>
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0.40</TD>
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133.8</TD>
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0.0</TD></TR></TBODY></TABLE>
 
 
 
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Steroid 처방 량 반 만을 사용</TD></TR>
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매일 두 번 Steroid 를 흡입하는 자는 
 처방 받은 약을 물론  전 량 사용  했다
 
 그러나 증상이 나타 날 때만 Steroid를 흡입한 군은 
 처방 받은  Steroid를 반 량 정도 남기고 있었음이 밝혀 졌다
 
 상술한 바와 같이 응급용 Salbutamol도 거의 사용 치 않했다
 
 
<IMG src="/_dimg/3-3%20약리%2020141215_173643.png">
[그림] 천식 약들의 작용점 
Corticosteoroid, ---점막 부종억제등  염증 억제 
Leukotriene receptor Antagonist-----염증 유발 수용체길항제
 Cromoglycate----비만 세포(Mast cell)막 안정화 제 
Antihistamine ----항히스타민제 -
Anticholinergic----항코린성 기관지 확장제)
 Xanthine계 기관지 확장제 
베타-2 흥분성 기관지 확장제</TD></TR></TBODY></TABLE>
 
 
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[근거]</TD></TR>
<TR style="mso-yfti-irow: 1; mso-yfti-lastrow: yes">
<TD style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; BACKGROUND-COLOR: transparent; PADDING-LEFT: 5.4pt; WIDTH: 430.65pt; PADDING-RIGHT: 5.4pt; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid; " width=574>
<SPAN style="BORDER-BOTTOM: windowtext 1pt; BORDER-LEFT: windowtext 1pt; PADDING-LEFT: 0cm; PADDING-RIGHT: 0cm; COLOR: #333333; FONT-SIZE: 12pt; BORDER-TOP: windowtext 1pt; BORDER-RIGHT: windowtext 1pt; mso-border-alt: none windowtext 0cm; mso-bidi-font-family: Helvetica; " >JAMA. 2012 September 12;308(10):987-997.
<SPAN style="BORDER-BOTTOM: windowtext 1pt; BORDER-LEFT: windowtext 1pt; PADDING-LEFT: 0cm; PADDING-RIGHT: 0cm; COLOR: #333333; FONT-SIZE: 12pt; BORDER-TOP: windowtext 1pt; BORDER-RIGHT: windowtext 1pt; mso-border-alt: none windowtext 0cm; " >Comparison of Physician-, Biomarker-, and Symptom-Based Strategies for Adjustment of Inhaled Corticosteroid Therapy in Adults WithAsthmaThe BASALT Randomized Controlled Trial
<SPAN style="BORDER-BOTTOM: windowtext 1pt; BORDER-LEFT: windowtext 1pt; PADDING-LEFT: 0cm; PADDING-RIGHT: 0cm; COLOR: #333333; FONT-SIZE: 12pt; BORDER-TOP: windowtext 1pt; BORDER-RIGHT: windowtext 1pt; mso-border-alt: none windowtext 0cm; mso-bidi-font-family: Helvetica; " >William J. Calhoun, MD <SPAN style="BORDER-BOTTOM: windowtext 1pt; BORDER-LEFT: windowtext 1pt; PADDING-LEFT: 0cm; PADDING-RIGHT: 0cm; COLOR: #333333; FONT-SIZE: 12pt; BORDER-TOP: windowtext 1pt; BORDER-RIGHT: windowtext 1pt; mso-border-alt: none windowtext 0cm; " >William J. Calhoun, MD; Bill T. Ameredes, PhD; Tonya S. King, PhD; NikolinaIcitovic, MAS; Eugene R. Bleecker, MD; Mario Castro, MD; Reuben M. Cherniack, MD; Vernon M. Chinchilli, PhD; Timothy Craig, DO; Loren Denlinger, MD, PhD; Emily A. DiMango, MD; Linda L. Engle, BS; John V. Fahy, MD; J. Andrew Grant, MD; Elliot Israel, MD; NizarJarjour, MD; Shamsah D. Kazani, MD; Monica Kraft, MD; Susan J. Kunselman, MA; Stephen C. Lazarus, MD; Robert F. Lemanske, MD; NjiraLugogo, MD; Richard J. Martin, MD; Deborah A. Meyers, PhD; Wendy C. Moore, MD; Rodolfo Pascual, MD; Stephen P. Peters, MD, PhD; Joe Ramsdell, MD; Christine A. Sorkness, PharmD; E. Rand Sutherland, MD; Stanley J. Szefler, MD; Stephen I. Wasserman, MD; Michael J. Walter, MD; Michael E. Wechsler, MD; Homer A. Boushey, MD; for the Asthma Clinical Research Network of the National Heart, Lung, and Blood Institute
<SPAN style="BORDER-BOTTOM: windowtext 1pt; BORDER-LEFT: windowtext 1pt; PADDING-LEFT: 0cm; PADDING-RIGHT: 0cm; COLOR: #333333; FONT-SIZE: 12pt; BORDER-TOP: windowtext 1pt; BORDER-RIGHT: windowtext 1pt; mso-border-alt: none windowtext 0cm; mso-bidi-font-family: Helvetica; " >. 
Department of Internal Medicine,University of Texas Medical Branch, Galveston;Department of Public Health Sciences, Penn State University, State College, Pennsylvania;School of Medicine, Wake Forest University, Winston-Salem,North Carolina 
Department of Medicine, Washington University, St Louis, Missouri ;National Jewish Health, Denver, Colorado Asthma Research Program, University of Wisconsin Hospital and Clinic, Madison ; Department of Medicine,Columbia University, New York, New York ; Department of Medicine, University of California,
San Francisco ;Brigham and Women’s Hospital, Boston, Massachusetts ; Department of Medicine, Duke University, Durham, North Carolina ; Department of Medicine,University of California, San Diego School of Medicine,University of Colorado, Denver 
 
 
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