支气管哮喘患儿缓解期不同激素吸入治疗方案与疗效的关系

Effects of Different Glucocorticosteroid Inhalation Regimens for Remissive Children with Asthma

目的研究支气管哮喘(哮喘)缓解期患儿糖皮质激素(GCS)不同吸入治疗方案与缓解治疗期个体依从性及疗效的关系。方法轻、中度哮喘患儿323例,采用硫酸特布他林250μg/次,3次/d;布地奈德200μg/次,2次/d吸入治疗。必要时加用口服支气管扩张剂治疗4周,临床缓解后进入为期12周的缓解期治疗;将缓解治疗患儿随机分为3组,布地奈德100μg,1次/d(A组);100μg.2次/d(B组);200μg,1次/d(C组)。分别于第4、8、12周调查吸入依从性.同时进行日间、夜间评分和(或)肺功能测定.并于第12周末对其疗效进行分析。结果中度哮喘活动期B组87%以上在4周内达到临床缓解;缓解治疗期随时间延长,虽然各组吸入依从率均逐渐降低,但以B组最明显,与A、C组比较均有显著差异(P<0.05,0.01),吸入依从率与用药剂量和用药次数均密切相关,12周结束时吸入缓解率C组明显高于A组(P<0.01);总缓解率C组明显高于A组(P<0.01)和B组(P<0.05)。结论布地奈德200μg2次/d,可有效控制轻、中度哮喘;200μg/d可使80%以上的哮喘息儿持续临床缓解。布地奈德吸入治疗应个体化。

Objective To study the effects of different glucocorticosteroid（GCS） inhalation regimens for remissive children with asthma. Methods Three hundred and twenty three patients with moderate, derate asthma were enrolled on a 12-week randomized parallel-group remissive treatment after a 4 -week baseline treatment. During the baseline treatment terhutaline sulfate 250μg tid a day and bud esonide 200μg twice a day were given, and oral hronchodilators were used if necessary. The remissive treatment were composed of budesonide inhalation 100μg once a day （group A）, 100 μg twice a day（group B） and 200μg once a day（group C）. Patients subsequently returned to the clinic for 3 additional clinic visits （4,8 and 12 weeks） or telephone visits . On every clinic visit, the daytime and nocturnal time severity score were recorded and spirometry was conducted in patients who were capable of performing the maneuver. Results Ultimately, 323 children were enrolled on the baseline treatment and 281 （87%） children achieved clinical remission. The rate of compliance deereased gradually during t he remissive treatment, but in group B（ P 〈 0.05 ） and group C （ P 〈 0.01 ） regiments were greatly higher than those of group A at the end of remissive treatment. The remissive rate of group A and group （who had finished the 12 - week remissive treatment the regiments were greatly higher than those in group A（ P〈0.01）. The total remissive rate of group C was markedly higher than that in group A（ P 〈 0.01 ） and group B（P〈 0.05 ）. Conclusions Budesonide by turbehaler 418μg/d, twice a day for baseline treatment and 200μg/d for remissive treatment may achieve ideal clinical effects to Chinese children w;th moderate asthma, and it is better once daily than twice daily with the same daily dose during remissive treatment. The responses to budesonide in individuals may be different, so inhalation regimen shall be used specifically.