Devulapalli Chandra Sekhar, Lødrup Carlsen Karin C, Håland Geir, Munthe-Kaas Monica C, Pettersen Morten, Mowinckel Petter, Carlsen Kai-Håkon
Department of Paediatrics, Division of Woman and Child, Ullevål University Hospital, Oslo, Norway.
Respir Med. 2007 Aug;101(8):1625-32. doi: 10.1016/j.rmed.2007.03.011. Epub 2007 May 21.
It is debated whether early treatment with inhaled corticosteroids (ICS) can change the natural course of childhood asthma.
To assess if ICS treatment before 2 years of age in children with obstructive airways disease reduces current asthma at 10 years of age.
Children with (n=233) and without (n=219) recurrent (r) bronchial obstruction (BO) attending clinical examination at 2 years of age in the birth cohort Environment and Childhood Asthma study in Oslo, were reinvestigated at 10 years of age. Current asthma (CA) at 10 years was defined as asthma with either symptoms and/or asthma treatment during the last year, and/or 10% fall in forced expired volume in 1s after standardized treadmill run. The risk of CA was assessed by logistic regression and propensity modelling (including gender, parental atopy and severity score at 2 years) in children with rBO who received ICS or not by 2 years.
CA was found in 97 children, more often among rBO children with (56.9%) and without ICS treatment (30.8%) compared to no-BO children (5.5%) (p<0.001). In rBO children logistic regression analyses (adjusted odds ratio aOR (95% confidence interval)) identified male gender (aOR 1.82 (1.01-3.27), p=0.046) and severity score at 2 years 1.14 (1.03-1.28), (p=0.01), as significant and ICS treatment as non-significant 2.00 (0.98-4.12) risk factors for CA. With propensity modelling adjusting for disease severity, ICS treatment by 2 years caused a non-significant increased risk aOR of CA of 1.84 (0.89-3.82).
No evidence was found that early use of ICS before age two in children with rBO reduces current asthma 8 years later.
吸入性糖皮质激素（ICS）早期治疗能否改变儿童哮喘的自然病程仍存在争议。
评估2岁前对患有阻塞性气道疾病的儿童进行ICS治疗是否能降低其10岁时患哮喘的几率。
在奥斯陆开展的“环境与儿童哮喘”出生队列研究中，对2岁时接受临床检查的患有复发性（r）支气管阻塞（BO）的儿童（n = 233）和未患该病的儿童（n = 219）在10岁时进行再次调查。10岁时的当前哮喘（CA）定义为在过去一年中有哮喘症状和/或接受哮喘治疗，和/或在标准化跑步机跑步后1秒用力呼气量下降10%。通过逻辑回归和倾向模型（包括性别、父母特应性和2岁时的严重程度评分）评估2岁时接受或未接受ICS治疗的rBO儿童患CA的风险。
97名儿童被发现患有CA，与无BO儿童（5.5%）相比，患有（56.9%）和未接受ICS治疗（30.8%）的rBO儿童中患CA的情况更为常见（p<0.001）。在rBO儿童中，逻辑回归分析（调整后的优势比aOR（95%置信区间））确定男性性别（aOR 1.82（1.01 - 3.27），p = 0.046）和2岁时的严重程度评分1.14（1.03 - 1.28），（p = 0.01）为CA的显著风险因素，而ICS治疗则为非显著风险因素，aOR为2.00（0.98 - 4.12）。通过倾向模型对疾病严重程度进行调整后，2岁时接受ICS治疗导致CA的风险aOR非显著增加，为1.84（0.89 - 3.82）。
未发现证据表明2岁前对rBO儿童早期使用ICS能降低8年后患当前哮喘的几率。
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