Sun Li-hong, Chen Ai-huan, Zhang Yi
Guangzhou Institute of Respiratory Disease, First Affiliated Hospital, Guangzhou Medical College, Guangzhou 510120, China.
Zhonghua Er Ke Za Zhi. 2008 Feb;46(2):85-8.
To compare the effects of inhaled corticosteroids (ICS) and oral leukotriene modifier (LTM) montelukast on the prognosis of children with cough variant asthma (CVA), and to identify the related risk factors for the development of classic asthma in children with CVA.
Eighty-four children with CVA (2 - 6 yrs) were randomized to receive inhaled beclomethasone dipropionate 200 microg/d through pressurized metered-dose inhaler (MDI) plus spacer with mask or oral montelukast 5 mg, once at bedtime for 6 months, then followed by 18 months observation period after the end of the study medication.
There was no significant difference in antitussive days between the two groups (ICS group: 14 +/- 9 days, LTM group: 13 +/- 9 days, Z = 1.12, P = 0.25). Wheezing developed in 7.1% of the children in ICS group during 24 months follow-up period, which was significantly lower than that in LTM group (33.3%, chi2 = 8.92, P = 0.003). The prevalence of eczema or allergic rhinitis was higher in children who developed wheezing than those who did not develop wheezing (eczema: 47.1% vs. 19.4%, chi(2) = 4.16, P = 0.042; allergic rhinitis: 58.8% vs. 31.3%, chi2 = 4.40, P = 0.036). Logistic regression analysis confirmed that eczema and allergic rhinitis were risk factors for wheezing development in children with CVA, the odds ratio was 7.668 and 3.855 respectively (P < 0.05 for all). But administration of ICS was negatively correlated with the development of wheezing by an odds ratio of 0.128 (P = 0.008).
Children with CVA may progress to classic asthma; eczema and allergic rhinitis are two risk factors for wheezing development in children with CVA. Both ICS and LTM are effective antitussive treatment, but ICS may be more effective than LTM on preventing the progression of CVA to classic asthma.
比较吸入性糖皮质激素（ICS）与口服白三烯调节剂（LTM）孟鲁司特对咳嗽变异性哮喘（CVA）患儿预后的影响，并确定CVA患儿发展为典型哮喘的相关危险因素。
84例2至6岁的CVA患儿被随机分为两组，一组通过带面罩的压力定量吸入器（MDI）加储雾罐吸入丙酸倍氯米松200μg/d，另一组口服孟鲁司特5mg，均于睡前服用，疗程6个月，研究用药结束后随访18个月。
两组的止咳天数无显著差异（ICS组：14±9天，LTM组：13±9天，Z = 1.12，P = 0.25）。在24个月的随访期内，ICS组7.1%的患儿出现喘息，显著低于LTM组（33.3%，χ2 = 8.92，P = 0.003）。出现喘息的患儿中湿疹或过敏性鼻炎的患病率高于未出现喘息的患儿（湿疹：47.1%对19.4%，χ2 = 4.16，P = 0.042；过敏性鼻炎：58.8%对31.3%，χ2 = 4.40，P = 0.036）。Logistic回归分析证实，湿疹和过敏性鼻炎是CVA患儿喘息发生的危险因素，比值比分别为7.668和3.855（均P < 0.05）。但使用ICS与喘息发生呈负相关，比值比为0.128（P = 0.008）。
CVA患儿可能进展为典型哮喘；湿疹和过敏性鼻炎是CVA患儿喘息发生的两个危险因素。ICS和LTM均为有效的止咳治疗方法，但ICS在预防CVA进展为典型哮喘方面可能比LTM更有效。
