Wong Jackson, Davies Tim, O'Callaghan Christopher
Department of Child Health and Institute of Lung Health, University of Leicester, Clinical Sciences Building, Leicester Royal Infirmary, United Kingdom.
J Allergy Clin Immunol. 2002 Nov;110(5):721-7. doi: 10.1067/mai.2002.128858.
Information on the dose of steroid infants inhale from spacer devices and its potential effect on adrenal suppression is limited.
We sought to determine the total dose of fluticasone propionate (FP) inhaled from a spacer device (Babyhaler) with face mask attachment by infants recovering from acute bronchiolitis and the effect of inhaled FP on the infants' overnight urinary cortisol/creatinine ratios (UCCRs).
Infants studied were recovering from acute bronchiolitis. In study 1, 22 infants inhaled 150 microg of FP through the Babyhaler. The likely inhaled dose was estimated by trapping it on a filter held within the face mask. In study 2, 40 infants had UCCRs measured before and during 3 months of treatment with either FP (150 microg twice daily, n = 20) or placebo (n = 20).
In study 1 the mean +/- SD dose of captured FP was 12.8 +/- 6.9 microg (ie, 2.1 +/- 1.2 microg/kg). In study 2 the pretreatment UCCR medians (interquartile ranges) were as follows: FP, 22.8 (23.0) nmol/mmol; placebo, 24.0 (28.3) nmol/mmol. Within-group UCCR changes (median and interquartile range DeltaUCCR) were significantly different in the FP group (-8.9 and -20.6 nmol/mmol at 6 weeks and -12.6 and -25.9 nmol/mmol at 12 weeks, respectively; P =.0008) but not in the placebo group ( -5.8 and -10.7 nmol/mmol at 6 weeks and +0.3 and -17.9 nmol/mmol at 12 weeks, respectively; P =.45). Intergroup changes were insignificant in the follow-up period (6 weeks, P =.52; 12 weeks, P =.19).
After bronchiolitis, infants are likely to inhale approximately 8 % of the nominal steroid dose from the Babyhaler. UCCRs can be used to monitor the bioavailability of inhaled steroids in young infants.
关于婴儿从储雾罐装置吸入的类固醇剂量及其对肾上腺抑制的潜在影响的信息有限。
我们试图确定从带有面罩的储雾罐装置（婴儿雾化器）吸入丙酸氟替卡松（FP）的急性细支气管炎恢复期婴儿的总剂量，以及吸入FP对婴儿夜间尿皮质醇/肌酐比值（UCCRs）的影响。
研究对象为急性细支气管炎恢复期的婴儿。在研究1中，22名婴儿通过婴儿雾化器吸入150微克FP。通过将其捕获在面罩内的滤器上估计可能吸入的剂量。在研究2中，40名婴儿在3个月的FP（每日两次，每次150微克，n = 20）或安慰剂（n = 20）治疗前后测量UCCRs。
在研究1中，捕获的FP的平均±标准差剂量为12.8±6.9微克（即2.1±1.2微克/千克）。在研究2中，治疗前UCCR中位数（四分位间距）如下：FP组，22.8（23.0）纳摩尔/毫摩尔；安慰剂组，24.0（28.3）纳摩尔/毫摩尔。FP组组内UCCR变化（中位数和四分位间距ΔUCCR）有显著差异（6周时分别为-8.9和-20.6纳摩尔/毫摩尔，12周时分别为-12.6和-25.9纳摩尔/毫摩尔；P =.0008），而安慰剂组无显著差异（6周时分别为-5.8和-10.7纳摩尔/毫摩尔，12周时分别为+0.3和-17.9纳摩尔/毫摩尔；P =.45）。随访期间组间变化无显著差异（6周，P =.52；12周，P =.19）。
细支气管炎后，婴儿可能从婴儿雾化器吸入约8%的名义类固醇剂量。UCCRs可用于监测幼儿吸入类固醇的生物利用度。
