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吸入性糖皮质激素的主要副作用

Authors
Kenneth G Saag, MD, MSc
Daniel E Furst, MD
Peter J Barnes, DM, DSc, FRCP, FRS
Section Editors
Bruce S Bochner, MD
Robert A Wood, MD
Deputy Editor
Helen Hollingsworth, MD
Translators
胡艳, 主治医师

引言

吸入性糖皮质激素[也被称为吸入性皮质类固醇(inhaled corticosteroid, ICS)]的不良反应比口服糖皮质激素少且严重程度也更轻，被广泛用于治疗哮喘和慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)[1]。然而，人们对于ICS在婴儿、儿童和年龄较大成人中的全身性作用有所担忧，尤其是因为其可能长期使用[2,3]。自从30年前ICS被引入哮喘的治疗后，研究者便对其安全性进行了广泛的研究[4-9]。

本专题将介绍ICS的局部和全身副作用，并讨论患者经常提出的关于这类药物的其他担忧。用于哮喘治疗的不同类型的吸入器和口服给药糖皮质激素的众多副作用将单独详细总结。 (参见“成人吸入装置的用法”和“The use of inhaler devices in children”和“全身性应用糖皮质激素的主要副作用”)

局部沉积的影响

可能发生由于吸入性糖皮质激素局部沉积于口咽部及喉部而引起的副作用。患者所述副作用的发生率取决于具体药物、剂量、给药频率、吸入器技术以及所用给药系统。

发音障碍 — 发音障碍(声音嘶哑)是使用吸入性糖皮质激素(ICS)的患者中一种常见主诉。报道的发生率为1%-60%不等，这取决于患者人群、装置、剂量、观察期长度及数据收集方式[10-13]。关于基于氢氟烷(hydrofluoroalkane, HFA)的定量吸入器(metered dose inhaler, MDI)的可用数据有限，但基于HFA的吸入器引发发音障碍的风险似乎低于基于氯氟烃(chlorofluorocarbon, CFC)的老款MDI，后者已基本停用[13]。MDI装置联合储雾器有时可减少发音障碍，但结果存在差异[12,13]。布地奈德干粉吸入器(dry powder inhaler, DPI)引发发音障碍的风险可能比CFC-MDI或氟替卡松DPI低，但难以对药物、剂量和设备进行比较[11]。一项研究纳入了使用氟替卡松DPI的患者，发现发音障碍的总体发生率为20%，在65岁以上女性患者中的发生率为36%[14]。

ICS相关发音障碍的产生机制可能包括如喉部肌肉肌病(表现为声带内收时关闭不全或弓形弯曲)、黏膜刺激和喉假丝酵母菌病等因素[15]。当停止治疗时，肌病或黏膜刺激所致的发音障碍是可逆的[15]。尽管发音障碍对于许多患者并无大碍，但是它对于歌手和讲师而言可能会是致失能性的。

                       

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Literature review current through: 2017-07 . | This topic last updated: 2016-04-01.
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