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【medical-news】部分哮喘儿童可不必每天连续应用
Dr. Markku T. Turpeinen and co-authors studied 176 children ages 5 to 10 years with asthma duration of at least 1 month and significant bronchial reversibility.
Following a 2-week run-in period in which the short-acting beta-2 agonist terbutaline was used as needed, the patients were assigned to one of three treatment groups:
Group 1, continuous budesonide, starting at 400 µg BID for 1 month, then 200 µg BID for 5 months, followed by 100 µg BID for 12 months (n = 58).
Group 2, budesonide/placebo, with identical budesonide treatment as Group 1 for 6 months, followed by placebo for 12 months (n = 58).
Group 3, open-label disodium cromoglycate (DSCG) 10 mg TID for 18 months (n = 60).
All patients were given terbutaline 0.25 mg per dose as needed as rescue medication. Acute exacerbations were treated with budesonide 400 µg BID for 2 weeks, followed by removal from the study if further treatment was required.
As reported in the August issue of the Archives of Disease in Childhood, asthma deterioration caused withdrawal of three patients from Group 1 and nine from Group 2, all within the last 12 months of the study. In Group 3, eight were withdrawn within the first 6 months and four within the last 12 months.
The number of exacerbations during months 1-6 was 0.32 per patient in Groups 1 and 2, and 1.24 per patient in Group 3 (p < 0.001). During months 7-18, the number of episodes per patient was significantly lower in Group 1 (0.97) than in Groups 2 (1.69) and Group 3 (1.58).
Lung function (FEV1) was better during the first 6 months on budesonide than on DSCG, although high-dose ICS was associated with a significant decline in growth velocity (2 cm/year slower than in the DSCG group).
However, growth velocity normalized during the last 12 months, during which time the number of asthma-free days did not differ between Groups 1 and 2.
Thus, Dr. Turpeinen's group concludes, "The dose of ICS could be reduced as soon as asthma is controlled. Some children do not seem to need continuous ICS treatment."
By contrast, they maintain that "the initially high number of exacerbations suggests that DSCG is not suitable to start treatment of newly detected childhood asthma."
In an accompanying Perspective article, Dr. Soren Pedersen comments that "mild asthma is not as trivial a disease as the name implies," which, owing to its high prevalence, accounts for many exacerbations and the majority of acute asthma hospitalizations and emergency-room visits. Although continuous ICS is the treatment of choice in guidelines, many patients and their physicians under-treat the condition because they underestimate its daily morbidity.
The editorialist, from Kolding Hospital in Denmark, takes exception to the initially high dose of budesonide used in the Helsinki study, pointing out that daily doses above 200 µg are not supported in clinical studies of patients with mild asthma.
Furthermore, because young children who can safely transition to intermittent dosing cannot be identified at treatment outset, Dr. Pedersen stresses that "regular follow-up is required in patients with mild disease. Otherwise we may go from under-treatment to over-treatment of this group of patients."
Arch Dis Child. 2008;93:644-645, 654-659.
Reuters Health Information 2008. © 2008 Reuters Ltd. August 8, 2008 — Once children with early, mild persistent asthma achieve good control over their symptoms using regular daily inhaled corticosteroids (ICS), the dose can be lowered, and in some cases, administered on an as-needed basis, according to research conducted at the Helsinki University Hospital in Finland.
2008年8月8日-儿童患有早期、轻微的持续哮喘，良好地控制症状需要有规律的每天吸入皮质激素类（ICS），根据芬兰赫尔辛基大学医院的研究，在一些病例中，基于恰如所需的管理，这种剂量可以降低。
Dr. Markku T. Turpeinen and co-authors studied 176 children ages 5 to 10 years with asthma duration of at least 1 month and significant bronchial reversibility.
Markku T. Turpeinen博士和他的合著者研究了176名从5岁到10岁，持续至少一个月、重要的支气管具有可逆性的哮喘患儿。
Following a 2-week run-in period in which the short-acting beta-2 agonist terbutaline was used as needed, the patients were assigned to one of three treatment groups:
接下来为期两周的实验中，短效β-2受体兴奋剂特布他林在必要时使用，病人分为三个治疗组：
Group 1, continuous budesonide, starting at 400 µg BID for 1 month, then 200 µg BID for 5 months, followed by 100 µg BID for 12 months (n = 58).
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作者:admin@医学,生命科学 2011-02-20 17:14
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