目的：比较不同吸入装置规律吸入糖皮质激素（inhaled corticosteroids, ICS）联合按需使用短效β₂受体激动剂（short-acting β₂-receptor agonist, SABA）对初诊轻度支气管哮喘患者症状、呼吸阻抗、肺功能及气道炎症的影响。方法： 前瞻性纳入53例初诊轻度支气管哮喘患者，采用SAS 9.4统计软件，按照试验组和对照组1:1的比例进行受试者随机分配，分为加压定量吸入器（pressurized metered-dose inhaler, pMDI）组26例和干粉吸入器（dry powder inhaler, DPI）组27例，均接受布地奈德200 μg/次、2次/d，维持治疗4周。分别于治疗前后评估哮喘控制测试（asthma control test, ACT）评分、肺功能、脉冲振荡（impulse oscillometry, IOS）参数、呼出气一氧化氮（fractional exhaled nitric oxide, FeNO）及血嗜酸性粒细胞（eosinophil, EOS）水平。结果：2组基线资料、肺功能、IOS、FeNO及EOS等差异均无统计学意义（P>0.05）。IOS参数与肺功能指标存在相关性。治疗4周后，2组ACT评分较基线升高，FeNO及EOS均较基线降低，呼气峰流速（peak expiratory flow，PEF）较基线升高（均P<0.05）。pMDI组在用力呼出25%肺活量时最大瞬间呼气流量（forced expiratory flow at 25% of forced vital capacity, FEF_25%）改善值显著高于DPI组（P<0.05）。分层分析显示，合并小气道功能障碍（small airway dysfunction, SAD）或FeNO≥25 ppb或EOS≥150个/μL的患者中，pMDI组治疗后FEF_25%改善更明显（P<0.05）。pMDI组ACT评分达25分的比例显著高于DPI组。结论： 初诊轻度哮喘患者经4周布地奈德治疗后，pMDI组FEF_25%改善值和哮喘症状良好控制率高于DPI组，2组气道炎症改善及安全性方面相当。基线FEV₁舒张反应及小气道功能异常可预测pMDI对治疗的较好疗效。

Objective To compare the effects of regular inhaled corticosteroids (ICS) using different inhalation devices combined with on-demand short-acting β₂-receptor agonist (SABA) on symptoms, respiratory impedance, lung function and airway inflammation in newly diagnosed patients with mild bronchial asthma. Methods A total of 53 patients with newly diagnosed mild bronchial asthma were prospectively enrolled. Using SAS software (version 9.4), the participants were randomly assigned in a 1:1 ratio to a pressurized metered-dose inhaler (pMDI) group of 26 patients and a dry powder inhaler (DPI) group of 27 patients. Both groups received budesonide 200 μg per dose twice daily for 4 weeks. Asthma control test (ACT) scores, lung function, impulse oscillometry (IOS) parameters, fractional exhaled nitric oxide (FeNO) and blood eosinophil (EOS) levels were assessed before and after treatment. Results There were no significant differences in baseline data, lung function, IOS, FeNO or EOS between the 2 groups (P>0.05). IOS parameters were correlated with lung function indicators. After 4 weeks of treatment, ACT scores increased, while FeNO and EOS decreased, and peak expiratory flow (PEF) increased compared with baseline in both groups (all P<0.05). The improvement in forced expiratory flow at 25% of forced vital capacity (FEF_25%) in the pMDI group was significantly greater than that in the DPI group (P<0.05). Stratified analysis showed that in patients with small airway dysfunction (SAD), FeNO≥25 ppb, or EOS≥150 cells/μL, the pMDI group exhibited more significant FEF_25% improvement after treatment (P<0.05). The proportion of patients achieving an ACT score of 25 in the pMDI group was significantly higher than that in the DPI group. Conclusions After 4 weeks of budesonide treatment in patients with newly diagnosed mild asthma, the change in FEF_25% and the proportion with well-controlled symptoms were higher in the pMDI group than in the DPI group, while both are comparable in terms of airway inflammation improvement and safety. Baseline FEV₁ reversibility and abnormalities in small airway function may predict a better therapeutic effect of pMDI.