Anderson Sandra D
Department of Respiratory Medicine, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW.
Med J Aust. 2002 Sep 16;177(S6):S61-3. doi: 10.5694/j.1326-5377.2002.tb04821.x.
What we know: Exercise-induced asthma (EIA) occurs in up to 23% of schoolchildren. In 40% of children with demonstrable EIA, no clinical diagnosis of asthma has been made. Children with asthma and EIA have eosinophils in their sputum, consistent with active asthma. EIA is well controlled in 50%-65% of children with moderate to severe asthma, so that only a minority will need prophylactic therapy immediately before exercise. Beta(2)-agonists are not the most suitable therapy for preventing EIA if they need to be used on a daily basis. The severity of EIA appears to be an indirect index of the severity of airway inflammation. What we need to know: Do non-symptomatic children with EIA require treatment for asthma? Does failure to identify and treat children unaware of their airways narrowing after exercise lead to airflow limitation in the long term, particularly in the small airways? Can exercise, or surrogate tests used to identify EIA, also be used to assess children with asthma? What is the minimum dose of steroid required to inhibit EIA, as high doses of steroids may be inappropriate in children? What is the best prophylactic treatment for EIA in children whose asthma is otherwise well controlled by inhaled steroids? What is the best prophylactic treatment for EIA in children with frequent episodic asthma or mild persistent asthma? Are leukotriene antagonists alone better than beta(2)-agonists alone in preventing EIA throughout the day? How many children taking long-acting beta(2)-agonists twice daily, either alone or in combination with an inhaled steroid, experience breakthrough EIA during school and require rescue medication?
高达23%的学童患有运动诱发哮喘（EIA）。在可证实患有EIA的儿童中，40%未得到哮喘的临床诊断。患有哮喘和EIA的儿童痰液中有嗜酸性粒细胞，这与活动性哮喘相符。50%-65%的中重度哮喘儿童的EIA得到良好控制，因此只有少数儿童在运动前需要预防性治疗。如果需要每天使用β2激动剂来预防EIA，那么它并非最合适的治疗方法。EIA的严重程度似乎是气道炎症严重程度的一个间接指标。
无症状的EIA儿童是否需要进行哮喘治疗？未能识别并治疗那些运动后未意识到气道变窄的儿童，从长远来看是否会导致气流受限，尤其是在小气道方面？运动或用于识别EIA的替代测试能否也用于评估哮喘儿童？抑制EIA所需的最低类固醇剂量是多少，因为高剂量类固醇可能不适用于儿童？对于哮喘通过吸入类固醇得到良好控制的儿童，EIA的最佳预防性治疗是什么？对于频繁发作性哮喘或轻度持续性哮喘的儿童，EIA的最佳预防性治疗是什么？在预防全天的EIA方面，单独使用白三烯拮抗剂是否比单独使用β2激动剂更好？有多少每天两次服用长效β2激动剂的儿童，无论是单独服用还是与吸入类固醇联合服用，在学校期间会出现EIA发作并需要急救药物？
