Miraglia del Giudice Michele, Piacentini Giorgio L, Capasso Michele, Capristo Carlo, Maiello Nunzia, Boner Attilio L, Capristo Angelo F
Dipartimento di Pediatria, Seconda Università di Napoli, Napoli, Italy.
Respir Med. 2007 Aug;101(8):1809-13. doi: 10.1016/j.rmed.2007.02.010. Epub 2007 Apr 5.
It has been proposed that asthma control may be achieved in part by minimizing airway inflammation. The simultaneous effects of inhaled steroids associated with long-acting beta-agonists and leukotriene antagonists on pulmonary function and airway inflammation are still largely unexplored in children with moderate persistent asthma.
The aim of this study was to investigate the effects of add-on therapy with long-acting beta-agonists and leukotriene antagonists on FEV1 and exhaled nitric oxide levels (FENO) in children.
Forty-eight steroid-naïve atopic asthmatic children, 7-11 years of age, were randomly treated in four groups for two consecutive one-month periods, as follows: (1) first month: budesonide 200 microg twice daily; second month: budesonide 400 microg twice daily; (2) first month: budesonide 200 microg twice daily+formoterol 9 microg twice daily; second month: budesonide 200 microg twice daily+montelukast 5mg once daily; (3) first month: budesonide 200 microg twice daily+montelukast 5mg once daily; second month budesonide 200 microg+formoterol 9 microg twice daily; (4) first and second month: budesonide 400 microg twice daily.
All treatments resulted in a significant increase in lung function and a decrease in FENO compared with values at baseline. Budesonide+montelukast in combination was the most effective treatment for reducing FENO levels.
This study demonstrates that add-on therapy with montelukast plus low-dose budesonide is more effective than the addition of long-acting beta-agonists or doubling the dose of budesonide for controlling FENO in asthmatic children.
有人提出，通过尽量减少气道炎症可部分实现哮喘控制。在中度持续性哮喘儿童中，吸入性糖皮质激素联合长效β受体激动剂和白三烯拮抗剂对肺功能和气道炎症的同时作用仍 largely 未被探索。
本研究的目的是调查长效β受体激动剂和白三烯拮抗剂联合治疗对儿童第一秒用力呼气容积（FEV1）和呼出一氧化氮水平（FENO）的影响。
48 名 7 - 11 岁未使用过糖皮质激素的特应性哮喘儿童被随机分为四组，连续两个为期一个月的阶段接受治疗，如下：（1）第一阶段：布地奈德 200 微克，每日两次；第二阶段：布地奈德 400 微克，每日两次；（2）第一阶段：布地奈德 200 微克，每日两次 + 福莫特罗 9 微克，每日两次；第二阶段：布地奈德 200 微克，每日两次 + 孟鲁司特 5 毫克，每日一次；（3）第一阶段：布地奈德 200 微克，每日两次 + 孟鲁司特 5 毫克，每日一次；第二阶段：布地奈德 200 微克 + 福莫特罗 9 微克，每日两次；（4）第一阶段和第二阶段：布地奈德 400 微克，每日两次。
与基线值相比，所有治疗均导致肺功能显著改善和 FENO 降低。布地奈德 + 孟鲁司特联合治疗是降低 FENO 水平最有效的治疗方法。
本研究表明，孟鲁司特加低剂量布地奈德联合治疗在控制哮喘儿童 FENO 方面比添加长效β受体激动剂或使布地奈德剂量加倍更有效。
