Grigg J
Leicester Children's Asthma Centre, University of Leicester, Leicester LE2 7LX, UK.
Postgrad Med J. 2004 Sep;80(947):535-40. doi: 10.1136/pgmj.2003.014936.
Paediatric asthma best practice not only includes prescribing the correct therapeutic mix based on consensus guidelines, but also reducing therapy once control has been achieved. Clinicians should also be aware that asthma in young children is a heterogeneous entity, and a beneficial response to bronchodilators and/or inhaled steroids is not inevitable. In general, preschool children and infants should not be prescribed inhaled corticosteroids above 200 microg beclometasone dipropionate equivalent twice a day, or regular oral steroids, or long acting beta2-adrenoceptor agonists. New therapies such as anti-IgE antibodies are on the horizon, but these are unlikely to replace the established drug combinations. More likely is that the delivery of established drugs will become more convenient (for example, once a day inhaled corticosteroids, or season dependent prophylactic therapy).
儿童哮喘的最佳治疗方案不仅包括根据共识指南开出正确的治疗组合,还包括在病情得到控制后减少治疗。临床医生还应意识到,幼儿哮喘是一种异质性疾病,对支气管扩张剂和/或吸入性类固醇不一定会产生有益反应。一般来说,学龄前儿童和婴儿不应每天两次开具相当于200微克二丙酸倍氯米松以上的吸入性皮质类固醇、或常规口服类固醇、或长效β2肾上腺素能受体激动剂。抗IgE抗体等新疗法即将出现,但不太可能取代现有的药物组合。更有可能的是,现有药物的给药方式将变得更加方便(例如,每日一次的吸入性皮质类固醇,或季节性预防性治疗)。