Tamesis Grace P, Covar Ronina A
Department of Pediatrics, National Jewish Medical and Research Center, 1400 Jackson Street, Denver, CO 80206, USA.
Curr Opin Allergy Clin Immunol. 2008 Apr;8(2):163-7. doi: 10.1097/ACI.0b013e3282f50e9d.
This review describes recent studies in children that evaluated long-term outcomes of controller asthma medications.
The literature is replete with studies demonstrating the immediate profound effects of inhaled corticosteroids on symptom control, reduction in morbidity and mortality rates, improvement in lung function, bronchial hyperresponsiveness, and inflammatory markers. Recent evidence supports that even this most effective class of medication does not alter the progression of recurrent wheeze to asthma, and that its effects on decline in lung function are limited. The lack of evidence supporting the superiority of lower dose inhaled corticosteroids combined with a long-acting beta-agonist over a full dose inhaled corticosteroid with respect to long-term efficacy measures and growth effects suggests that monotherapy with acceptable inhaled corticosteroid dose is the preferred treatment in children with mild to moderate persistent asthma. Montelukast has been shown to significantly reduce asthma exacerbations and lower use of supplemental inhaled corticosteroids compared with placebo.
There is mounting evidence that the currently available medications for childhood asthma have a substantial impact on multiple dimensions of asthma control. No drug in our current armamentarium, however, has been found to alter the natural progression of childhood asthma nor halt progressive airway damage in the more susceptible children.
本综述描述了近期针对儿童进行的评估控制哮喘药物长期疗效的研究。
文献中有大量研究表明吸入性糖皮质激素对症状控制、发病率和死亡率降低、肺功能改善、支气管高反应性及炎症标志物有即刻显著效果。近期证据支持，即便这类最有效的药物也不会改变复发性喘息向哮喘的进展，且其对肺功能下降的影响有限。在长期疗效指标和生长效应方面，缺乏证据支持低剂量吸入性糖皮质激素联合长效β受体激动剂优于全剂量吸入性糖皮质激素，这表明对于轻度至中度持续性哮喘儿童，采用可接受剂量的吸入性糖皮质激素单药治疗是首选治疗方法。与安慰剂相比，孟鲁司特已被证明可显著减少哮喘发作并降低补充吸入性糖皮质激素的使用。
越来越多的证据表明，目前用于儿童哮喘的药物对哮喘控制的多个方面有重大影响。然而，在我们目前的药物库中，尚未发现有药物能改变儿童哮喘的自然病程，也无法阻止更易感儿童的气道进行性损伤。
