儿童哮喘中的呼气峰值流速变化：与吸入性糖皮质激素长期治疗期间的症状、气道阻塞及高反应性的相关性。荷兰CNSLD研究组
Peak flow variation in childhood asthma: correlation with symptoms, airways obstruction, and hyperresponsiveness during long-term treatment with inhaled corticosteroids. Dutch CNSLD Study Group.
作者信息
Brand P L, Duiverman E J, Waalkens H J, van Essen-Zandvliet E E, Kerrebijn K F
机构信息
Department of Paediatric Pulmonology, Isala Clinics/Weezenlanden Hospital, Zwolle, The Netherlands.
出版信息
Thorax. 1999 Feb;54(2):103-7. doi: 10.1136/thx.54.2.103.
BACKGROUND
Guidelines for asthma management focus on treatment with inhaled corticosteroids and on home recording of peak expiratory flow (PEF). The effect of maintenance treatment with inhaled corticosteroids on PEF variation and its relation to other parameters of disease activity were examined in 102 asthmatic children aged 7-14 years.
METHODS
During 20 months of treatment with inhaled salbutamol, with or without inhaled budesonide (600 micrograms daily), forced expiratory volume in one second (FEV1), the dose of histamine required to provoke a fall in FEV1 of more than 20% (PD20), the percentage of symptom free days, and PEF variation were assessed bimonthly. PEF variation was computed as the lowest PEF as a percentage of the highest PEF occurring over 14 days, the usual way of expressing PEF variation in asthma self-management plans. For each patient using inhaled corticosteroids within subject correlation coefficients (rho) were computed of PEF variation to the percentage of symptom free days, FEV1, and PD20.
RESULTS
PEF variation decreased significantly during the first two months of treatment with inhaled corticosteroids and then remained stable. The same pattern was observed for symptoms and FEV1. In contrast, PD20 histamine continued to improve throughout the whole follow up period. In individual patients predominantly positive associations of PEF variation with symptoms, FEV1, and PD20 were found, but the ranges of these associations were wide.
CONCLUSIONS
During treatment with inhaled corticosteroids the changes in PEF variation over time show poor concordance with changes in other parameters of asthma severity. When only PEF is monitored, clinically relevant deteriorations in symptoms, FEV1, or PD20 may be missed. This suggests that home recording of PEF alone may not be sufficient to monitor asthma severity reliably in children.
背景
哮喘管理指南侧重于吸入性糖皮质激素治疗以及在家中记录呼气峰值流速（PEF）。对102名7至14岁的哮喘儿童进行了研究，以探讨吸入性糖皮质激素维持治疗对PEF变异的影响及其与疾病活动其他参数的关系。
方法
在使用吸入沙丁胺醇（无论是否联合每日600微克吸入布地奈德）治疗的20个月期间，每两个月评估一次一秒用力呼气容积（FEV1）、使FEV1下降超过20%所需的组胺剂量（PD20）、无症状天数百分比以及PEF变异。PEF变异计算为14天内最低PEF占最高PEF的百分比，这是哮喘自我管理计划中表达PEF变异的常用方式。对于每个使用吸入性糖皮质激素的患者，计算PEF变异与无症状天数百分比、FEV1和PD20之间的受试者内相关系数（rho）。
结果
在吸入性糖皮质激素治疗的前两个月，PEF变异显著下降，然后保持稳定。症状和FEV1也观察到相同的模式。相比之下，PD20组胺在整个随访期间持续改善。在个体患者中，发现PEF变异与症状、FEV1和PD20主要呈正相关，但这些相关性的范围较宽。
结论
在吸入性糖皮质激素治疗期间，PEF变异随时间的变化与哮喘严重程度的其他参数变化的一致性较差。仅监测PEF时，可能会遗漏症状、FEV1或PD20的临床相关恶化情况。这表明仅在家中记录PEF可能不足以可靠地监测儿童哮喘的严重程度。
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