Perera B Jayasiri C
Asiri Hospital, Kirula Road, Colombo, Sri Lanka.
Respirology. 2005 Jun;10(3):385-8. doi: 10.1111/j.1440-1843.2005.00708.x.
Although inhaled corticosteroids are useful and effective in the prophylaxis of childhood asthma, there is a dearth of information regarding the duration of treatment. The present study was undertaken to assess the possibility of successful withdrawal of inhaled corticosteroids in childhood asthma following good control of the disease.
The study was carried out at the Asiri Hospital, Colombo, Sri Lanka and was a prospective observational clinical study. The participants were consecutive children with documented moderately severe and severe asthma seen over a period of 4 years from January 1990 and followed up to December 2003. Patients were allocated randomly to receive either beclomethasone dipropionate or budesonide. Initial dose of the selected drug was 300, 400 or 600 microg/day, depending on the child's age. After a period of stabilization, the dose was reduced from the starting dose to a maintenance level of 200, 300 or 400 microg/day, respectively. Once sustained control had been maintained for a period ranging from 9 to 18 months, gradual withdrawal was attempted. The dosage was reduced by 50-100 microg each time, at intervals of 3 months. Long-term follow up was maintained following withdrawal of inhaled corticosteroids. Breakthrough wheezing, acute severe attacks, hospitalization for wheezing and absence from school were used to assess the response.
Eighty-six children were recruited into the study. Eighty children responded well. The initial period on a high dose of corticosteroid was 8.4 months (range 4-12 months) and the average period of maintenance dosing was 11.7 months (range 9-18 months). The average time taken for withdrawal was 12.6 months (range 9-18 months). Successful withdrawal was achieved in 73 children. In this group, the mean total duration of treatment was 27.4 months (range 20-44 months). Up to December 2003, the subjects had been observed for an average period of 97.1 months (range 86-121 months) following withdrawal of inhaled corticosteroids. Of the 73 children in whom corticosteroids were withdrawn, 57 (78%) have remained well without any episodes of wheezing, and 14 (19%) have had mild episodes of wheezing that were easily controlled by bronchodilators. No patient needed hospitalization, long-term treatment or systemic corticosteroids. In two (3%) patients, it was necessary to restart inhaled corticosteroids because of troublesome recurrences.
It is possible to gradually withdraw inhaled corticosteroids in a significant proportion of asthmatic children once good control has been sustained on a maintenance dose for a considerable period.
尽管吸入性糖皮质激素在儿童哮喘的预防中有用且有效，但关于治疗持续时间的信息却很匮乏。本研究旨在评估在儿童哮喘病情得到良好控制后成功停用吸入性糖皮质激素的可能性。
该研究在斯里兰卡科伦坡的阿西里医院进行，是一项前瞻性观察性临床研究。研究对象为1990年1月至2003年12月期间连续就诊的有中度至重度哮喘记录的儿童，并进行随访。患者被随机分配接受二丙酸倍氯米松或布地奈德治疗。所选药物的初始剂量根据儿童年龄为300、400或600微克/天。经过一段时间的病情稳定后，剂量分别从起始剂量降至维持水平200、300或400微克/天。一旦维持持续控制9至18个月，便尝试逐渐停药。每次剂量减少50 - 100微克，间隔3个月。在停用吸入性糖皮质激素后进行长期随访。使用突破性喘息、急性重度发作、因喘息住院和缺课情况来评估反应。
86名儿童被纳入研究。80名儿童反应良好。高剂量糖皮质激素的初始治疗期为8.4个月（范围4 - 12个月），维持给药的平均时间为11.7个月（范围9 - 18个月）。停药的平均时间为12.6个月（范围9 - 18个月）。73名儿童成功停药。在这组儿童中，平均总治疗时间为27.4个月（范围20 - 44个月）。截至2003年12月，在停用吸入性糖皮质激素后，对这些受试者平均观察了97.1个月（范围86 - 121个月）。在73名停用糖皮质激素的儿童中，57名（78%）一直状况良好，没有任何喘息发作，14名（19%）有轻度喘息发作，通过支气管扩张剂很容易得到控制。没有患者需要住院、长期治疗或全身性糖皮质激素治疗。2名（3%）患者因复发情况棘手，有必要重新开始吸入性糖皮质激素治疗。
一旦在维持剂量下持续良好控制相当一段时间后，相当比例的哮喘儿童有可能逐渐停用吸入性糖皮质激素。
