Koh Young Yull, Park Yang, Kim Chang Keun
Department of Pediatrics, Clinical Research Institute, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul 110-744, Korea.
Chest. 2002 Oct;122(4):1214-21. doi: 10.1378/chest.122.4.1214.
Many children with asthma go into long-term clinical remission at adolescence, but bronchial hyperresponsiveness (BHR) persists in some of these subjects. BHR in asthma is characterized by an increase in sensitivity and in maximal airway response to bronchoconstrictor stimuli.
The aims of this study were to compare the profiles of maximal airway response between adolescents with asthma remission and adolescents with symptomatic asthma to a similar degree of airway hypersensitivity, and to determine whether maximal airway response in adolescents with asthma remission is reduced by prolonged treatment with inhaled corticosteroids.
A high-dose methacholine inhalation test was performed in 46 adolescents with long-term asthma remission (remission group) and 44 adolescents with symptomatic asthma (symptomatic group). Subjects exhibiting a maximal response plateau in the remission group were administered inhaled budesonide (400 microg bid, budesonide/remission group, n = 15) or identical placebo (placebo/remission group, n = 15) for 6 months, and the subjects in the symptomatic group were administered the same regimen of budesonide (budesonide/symptomatic group, n = 17). The plateau level was measured after 3 months and 6 months of treatment.
Thirty-four subjects (73.9%) in the remission group featured a maximal response plateau on the dose-response curve to methacholine, whereas 19 subjects (43.2%) in the symptomatic group had a plateau (p = 0.003). In neither the placebo/remission group nor the budesonide/remission group did the plateau level change significantly over the 6-month period, whereas budesonide markedly decreased the level in the budesonide/symptomatic group.
The difference in frequency of detection of a plateau between the remission group and the symptomatic group, as well as the difference in its response to treatment with budesonide between the two groups, suggests that inflammatory changes impact the maximal airway response in symptomatic asthmatic adolescents but not in adolescents with asthma remission.
许多哮喘儿童在青春期进入长期临床缓解期，但其中一些患者的支气管高反应性（BHR）仍然存在。哮喘中的BHR表现为对支气管收缩刺激的敏感性增加和最大气道反应增加。
本研究的目的是比较哮喘缓解期青少年和症状性哮喘青少年在气道高敏程度相似时的最大气道反应情况，并确定长期吸入糖皮质激素治疗是否会降低哮喘缓解期青少年的最大气道反应。
对46例长期哮喘缓解期青少年（缓解组）和44例症状性哮喘青少年（症状组）进行高剂量乙酰甲胆碱吸入试验。在缓解组中表现出最大反应平台期的受试者接受吸入布地奈德（400μg，每日两次，布地奈德/缓解组，n = 15）或相同的安慰剂（安慰剂/缓解组，n = 15）治疗6个月，症状组的受试者接受相同方案的布地奈德治疗（布地奈德/症状组，n = 17）。在治疗3个月和6个月后测量平台期水平。
缓解组中有34名受试者（73.9%）在乙酰甲胆碱剂量反应曲线上出现最大反应平台期，而症状组中有19名受试者（43.2%）出现平台期（p = 0.003）。在安慰剂/缓解组和布地奈德/缓解组中，平台期水平在6个月内均无显著变化，而布地奈德显著降低了布地奈德/症状组的水平。
缓解组和症状组在平台期检测频率上的差异，以及两组对布地奈德治疗反应的差异，表明炎症变化影响症状性哮喘青少年的最大气道反应，但不影响哮喘缓解期青少年的最大气道反应。
