Rytilä P, Pelkonen A S, Metso T, Nikander K, Haahtela T, Turpeinen M
Division of Allergy, Department of Medicine, Helsinki University Central Hospital, FIN-00029 Huch, Helsinki, Finland.
Allergy. 2004 Aug;59(8):839-44. doi: 10.1111/j.1398-9995.2004.00504.x.
There are few controlled studies on the effects of anti-inflammatory treatment on airway inflammation in newly diagnosed childhood asthma.
Sixty children with newly diagnosed mild persistent asthma, 5-10 years of age, and 17 healthy control subjects were studied. Asthmatic children were randomized into an open study with two treatment groups: (1) budesonide 400 microg twice daily for 1 month, 200 microg twice daily for 5 months and (2) disodium cromoglycate (DSCG) 10 mg three-times daily for 6 months. All exacerbations were treated with budesonide 400 microg twice daily for 2 weeks. Symptoms and lung function were recorded throughout the study.
Sputum induction was safe and the overall success rate was 71%. This improved with age and decreased after treatment. At baseline, the asthmatic children had more eosinophils in blood (0.26 vs 0.18 x 10(9)/l, P = 0.03) and sputum (1.1 vs 0.0 %, P = 0.0001) than the control subjects. The numbers of sputum eosinophils correlated with bronchial responsiveness (R = -0.58, P = 0.0002). Eosinophils were higher in children with atopic asthma than with nonatopic asthma (P < 0.0001), and in children with a history wheezing than in children without wheezing (P = 0.02). Six months of budesonide treatment, but not of DSCG, improved lung function (P = 0.007), decreased symptoms (P = 0.007) and sputum eosinophils (P = 0.003). The effects of budesonide were pronounced in children with intense sputum eosinophilia (>3%).
Sputum eosinophilia is present in children with newly diagnosed mild persistent asthma. Treatment with inhaled budesonide, but not with DSCG, decreases sputum eosinophils along with clinical and functional improvement.
关于抗炎治疗对新诊断的儿童哮喘气道炎症影响的对照研究较少。
对60名5至10岁新诊断为轻度持续性哮喘的儿童和17名健康对照者进行研究。哮喘儿童被随机分为一个开放研究的两个治疗组：（1）布地奈德400微克，每日两次，持续1个月，200微克，每日两次，持续5个月；（2）色甘酸钠（DSCG）10毫克，每日三次，持续6个月。所有发作均用布地奈德400微克，每日两次，治疗2周。在整个研究过程中记录症状和肺功能。
痰液诱导是安全的，总体成功率为71%。这随年龄增长而改善，治疗后下降。基线时，哮喘儿童血液（0.26对0.18×10⁹/L，P = 0.03）和痰液（1.1对0.0%，P = 0.0001）中的嗜酸性粒细胞比对照者更多。痰液嗜酸性粒细胞数量与支气管反应性相关（R = -0.58，P = 0.0002）。特应性哮喘儿童的嗜酸性粒细胞高于非特应性哮喘儿童（P < 0.0001），有喘息史的儿童高于无喘息史的儿童（P = 0.02）。布地奈德治疗6个月可改善肺功能（P = 0.007）、减轻症状（P = 0.007）和降低痰液嗜酸性粒细胞（P = 0.003），但色甘酸钠无此作用。布地奈德对痰液嗜酸性粒细胞强烈增多（>3%）的儿童效果显著。
新诊断的轻度持续性哮喘儿童存在痰液嗜酸性粒细胞增多。吸入布地奈德治疗可降低痰液嗜酸性粒细胞，同时改善临床症状和功能，而色甘酸钠则无此作用。
