Observing The Therapeutic Effect Of Treating Mild And Moderate Asthma With Inhaling Budesonide Alone Or Inhaling Budesonide Combining Formoterol

Objective:To compare the difference of the improvement in the lung function and clinical symptom score between inhaling glucocorticoid alone and inhaling glucocorticoid combining Long-acting[beta]-agonists and to compare the two medicine's cost efectiveness.Method:Selected 54 bronchial asthmatic patients visiting in out-patient clinic of first affiliated hospital of ShanXi medical university from December 2005 to July 2007,whose diagnose according with bronchial asthma guideline of prevention and management established by chinese Mdeical Association in 2003,simultaneously meeting the following conditions:(1) Course of disease was more than one year;(2) Being mild to moderate grade of chronic persistent period severity grade of asthma;(3) No use of the treatment of inhalating glucocorticoid;(4) Agree to accept the treat with long-term control medication including inhaled corticosteroid.Exclusion criteria:(1) I -class asthma,not needing the use of long-term control drugs;(2) Having serious heart,liver,kidney or other serious airway disease;(3) Occupational asthma;(4)Pregnancy and breast-feeding Women.Patients adropped randomly the following two treatments:Group A inhaled budesonide dry powder inhalation(glucocorticoid)combining formoterol dry powder inhalation(Long-acting [beta]-agonists),mild asthma inhaled budesonide 100 ug,bid,formoterol 4.5 ug,qd;moderate asthma budesonide 200 ug,bid,formoterol 4.5 ug,bid.Group B inhaled budesonide dry powder inhalation,mild asthma 200 ug,bid,moderate asthma 400 ug,bid.Observed the two groups's improvements to clinical symptom score and lung function before treatment and two weeks,one month,three months,six months after the medication,compared two groups' therapeutic efficacy and pharmacoeconomics。Lung function indexes including commonly used indexes-PEF,FVC,FEV1,indexes reflecting the airway obstruction--FEV_/ FVC,the small airway function indexes--FEF50%,FEF75%,FEF25～75%and FEF_50%%Pred,FEF_75%%Pred FEF_25-75%%Pred。Results:1.The dealing main effect(two kinds of treatments) P＞0.05,no statistical significance;the interaction of treatment effect with the effect of time(five period:before treatment,two weeks,one month,three months,six months after treatment) P＞0.05,I.e.there was not statistically difference between the the two treatment's trend along with time.Therefore, two methods ' therapeutic effect on ACT score and lung function is not different.2.Main effect of time(five periods) P＜0.001,the population mean of the various indexes measured at different time points are not the same.ACT score and lung function indexes value of the two groups increased greadually at the following time:before the treatment,two weeks,one month,three months and six months after the medication,and further comparison shows that:excepting the hightening of FEF75%,FEF_25%%Pred and FEF_75%%Pred have not statistic significance one month than two weeks after treatment,the heightening of ACT score and the other lung function Indexes value all have statistic significance at the four time after treatment.3.Both PEF and FEV₁ achieved more than 100%of the expected value after one month:PEF achieved 105.19 percent in group A,103.42 percent in group B,FEV₁ achieved 113.76 percent in group A,107.17 percent in group B.and continued to rise,after six months,PEF achieved 112.89 percent in group A,117.78 percent in group B,FEV₁ achieved 120.50 percent in group A,116.11 percent in group B.After six months,FEF25%achieved 104.67 percentage of the estimated value in group A,105.07 percent in group B;FEV1/FVC%achieved 71.48 percentage in group A,73.32 percent in group B;FEF50%,FEF75%,FEF25%-75%are still below 70 percent of their expected value,below normal.4.ACT score is 22.78 in group A,23.15 in group B after six months 5.Pharmacoeconomics:in group A total drug cost of budesonide and formoterol is 576 yua to mild asthma,1260 yuan to moderate asthma;in group B budesonide total cost is 432 yuan to mild asthma,864 yuan to moderate astahma.Conclusion:(1)Inhaling glucocorticoid alone or inhaling glucocorticoid combining Long-acting [beta]-agonists can effectively improve symptoms and lung function of mild to moderate grade chronic persistent period asthma,and combining inhaling can get the same effect with less glucocorticoid,about half of the dose of inhaling glucocorticoid alone.(2)Along with the medication time's extension,the clinical symptoms and each lung function indexes were gradually elevated.(3) the small airway blocking still exists half a year later,the small airway function indexes such as FEF50%,FEF75%,FEF25～75%were still not normal,it is possibly because of the airway remodeling;the long-term regular treat and monitoring the small airway function indexes are still necessary。(4) The cost of inspiration glucocorticoid alone is less than combining inspiration,can be used according to the state of business.