升级治疗在支气管哮喘病情控制中的临床研究

Utility of treatment options for high-grade asthma in the control of bronchial asthma

目的观察升级治疗与标准治疗对支气管哮喘的临床疗效，以求找出治疗哮喘最佳方法。方法对2009年1—12月在绍兴市人民医院哮喘专科门诊就诊的98例支气管哮喘病情未控制的患儿，随机分成标准治疗组与升级治疗组。标准治疗组按GINA和《儿童支气管哮喘诊断与防治指南》的分级标准进行治疗，升级治疗组则在此基础上升一个级别治疗4—8周，症状缓解、肺功能正常后给予降级治疗。治疗随访1年，每4周检测1次肺功能、症状评分（C—ACT），观察2组患儿的C—ACT、肺功能及不良反应。结果治疗后4周、8周升级治疗组C—ACT、肺功能明显好于标准治疗组；1年后2组患儿各项指标差异无统计学意义，不良反应2组差异无统计学意义。结论升级治疗是支气管哮喘治疗过程中可选取的方法之一，但需及时降级，以减少不良反应。

Objective To observe the clinical effects of standard treatment and treatment options for high-grade asthma in the treatment of bronchial asthma,and improve the treatment of bronchial asthma. Methods Total 98 children with uncontrolled bronchial asthma in our hospital from Jan. to Dec. 2009 were recruited and randomly divided into standard group and upgraded group. The standard group received the treatments faced to the GINA and ＂Guide to diagnosis and treatment of bronchial asthma in children＂ grading standards,while the upgraded group received the treatments option for the highgrade asthma for 4 to 8 weeks and return to the standard treatment after the symptomatic relief and recovery of pulmonary function. The patients were followed up for 1 year, and the pulmonal7 function assessment and childhood asthma control test（C-ACT） were performed every 4 weeks. The pulmonary function,C-ACT and adverse reaction were compared between the two groups. Results After treatment of 4 weeks and 8 weeks,pulmonary function and C-ACT in the upgraded group were improved obviously as compared to the standard group. One year later, all the indexes and adverse reaction had no significant difference between the two groups. Conclusion Upgrade therapy is one better choice in the treatment of bronchial asthma;the early treatment options for high-grade asthma can decrease the incidence of adverse reaction.