Kaminsky David A, Rice Ashlie A, Bissonette Michael, Larose Teresa, Phillips Lisa, Cohen Laura, Lahiri Thomas, Frankowski Barbara
Pulmonary/Critical Care, Fletcher Allen Health Care, University of Vermont, Burlington, Vermont, USA.
J Asthma. 2008 Jun;45(5):415-9. doi: 10.1080/02770900801971842.
Attendance at a summer asthma camp has been associated with improved outcomes in children with asthma. We hypothesized that one mechanism involved in improved asthma outcomes is reduction in airway inflammation. To investigate this, we measured the fractional concentration of exhaled nitric oxide (FeNO), lung function (forced expiratory volume in 1 sec, FEV(1)) and asthma control (Juniper Asthma Control Questionnaire, ACQ) from children at the beginning and end of a 1-week asthma summer camp. We also obtained a symptoms-only ACQ at 1 and 6 months after the end of camp. We enrolled 10 girls, 17 boys, mean (+/- SD) age = 9.6 +/- 1.3 years. At baseline, FeNO (ppb), median (25-75 IQR) = 11.4 (7.2-21.3); ACQ = 0.86 (0.43-1.21); FEV(1) (%pred, mean +/- SD) = 87 +/- 10. At the end of camp, FeNO = 6.2 (4.4-8.4), a change of -45%, p < 0.0001; ACQ = 0.71 (0.43-1.14), a fall of 14%, p = 0.72; and mean FEV(1)% predicted remained unchanged. There were no significant changes in the follow-up symptoms-only ACQ at 1 and 6 months. We conclude that airway inflammation, as measured by FeNO, improved during 1 week of asthma camp, but there were no significant changes in lung function or asthma control. Since no child had a change in anti-inflammatory therapy during camp, these findings suggest that airway inflammation was reduced because of improved adherence to therapy and/or reduced exposure to pro-inflammatory stimuli in the home environment. The finding of reduced inflammation following attendance at an asthma summer camp should motivate the child, the parents and the clinician to focus their efforts on improving adherence to therapy and reducing exposures at home.
参加夏季哮喘营与哮喘患儿病情改善有关。我们推测哮喘病情改善涉及的一种机制是气道炎症减轻。为了对此进行研究，我们在为期1周的哮喘夏令营开始和结束时，测量了患儿呼出一氧化氮的分数浓度（FeNO）、肺功能（1秒用力呼气容积，FEV₁）和哮喘控制情况（朱尼珀哮喘控制问卷，ACQ）。我们还在夏令营结束后的1个月和6个月获取了仅包含症状的ACQ。我们招募了10名女孩、17名男孩，平均（±标准差）年龄为9.6±1.3岁。基线时，FeNO（ppb），中位数（25 - 75四分位数间距）= 11.4（7.2 - 21.3）；ACQ = 0.86（0.43 - 1.21）；FEV₁（预计值%，平均±标准差）= 87±10。夏令营结束时，FeNO = 6.2（4.4 - 8.4），变化为 - 45%，p < 0.0001；ACQ = 0.71（0.43 - 1.14），下降了14%，p = 0.72；平均FEV₁预计值百分比保持不变。在1个月和6个月的随访中，仅包含症状的ACQ没有显著变化。我们得出结论，通过FeNO测量的气道炎症在哮喘营的1周内有所改善，但肺功能或哮喘控制情况没有显著变化。由于在夏令营期间没有患儿改变抗炎治疗，这些发现表明气道炎症减轻是因为治疗依从性提高和/或在家中接触促炎刺激物减少。参加哮喘夏令营后炎症减轻这一发现应促使患儿、家长和临床医生致力于提高治疗依从性并减少在家中的接触。
