Pelkonen A S, Malmström K, Malmberg L P, Sarna S, Turpeinen M, Kajosaari M, Haahtela T, Mäkelä M J
Department of Allergy, Skin and Allergy Hospital, Helsinki University Central Hospital, PO Box 160, FIN-00029 HUS, Finland.
Arch Dis Child. 2009 Jul;94(7):536-41. doi: 10.1136/adc.2007.132100. Epub 2009 Mar 1.
Inhaled corticosteroids (ICS) are commonly used to treat wheezing disorders in children, but few studies have investigated the effect of ICS on lung function in infants. We evaluated the efficacy of inhaled budesonide for decreased specific airway conductance (sGaw) as an indication of bronchial obstruction in very young children with recurrent cough and/or wheeze. PATIENTS, DESIGN AND INTERVENTIONS: Functional residual capacity (FRC) and sGaw of steroid-naive children aged 3-26 months with respiratory symptoms were measured using an infant whole-body plethysmograph. Clinically indicated bronchoscopy was performed in 79% of the patients to exclude anatomical abnormalities before randomisation. Children with abnormal lung function and respiratory symptoms were randomised into two treatment groups, receiving either inhaled budesonide (400 microg/day) or placebo with NebuChamber for 6 weeks. Inhaled terbutaline 0.25 mg/dose was used as a rescue medication. Lung function measurements were repeated after 6 weeks.
Lung function.
44 children with a median age of 11.3 months (range 3.7-25.9) completed the study. Median sGaw improved from a z score of -3.6 to -1.2 (p<0.001) in the budesonide group and from -3.2 to -2.6 (p = 0.033) in the placebo group; between group difference p = 0.014. Improvement in sGaw was more pronounced in children with atopy (p = 0.017). Symptom-free days increased in both the budesonide and placebo groups with no difference between groups.
Treatment with inhaled budesonide for 6 weeks improved sGaw in young children with chronic cough or wheeze and bronchial obstruction.
吸入性糖皮质激素（ICS）常用于治疗儿童喘息性疾病，但很少有研究调查ICS对婴儿肺功能的影响。我们评估了吸入布地奈德对降低比气道传导率（sGaw）的疗效，以此作为反复咳嗽和/或喘息的幼儿支气管阻塞的指标。
患者、设计与干预措施：使用婴儿全身体积描记法测量3至26个月有呼吸道症状且未使用过类固醇的儿童的功能残气量（FRC）和sGaw。79%的患者在随机分组前进行了临床指征的支气管镜检查以排除解剖学异常。肺功能异常且有呼吸道症状的儿童被随机分为两个治疗组，分别接受吸入布地奈德（400微克/天）或使用雾化吸入器的安慰剂治疗6周。吸入特布他林0.25毫克/剂用作急救药物。6周后重复进行肺功能测量。
肺功能。
44名中位年龄为11.3个月（范围3.7 - 25.9个月）的儿童完成了研究。布地奈德组的中位sGaw从z值-3.6改善至-1.2（p<0.001），安慰剂组从-3.2改善至-2.6（p = 0.033）；组间差异p = 0.014。特应性儿童的sGaw改善更为明显（p = 0.017）。布地奈德组和安慰剂组的无症状天数均增加，组间无差异。
吸入布地奈德治疗6周可改善患有慢性咳嗽或喘息及支气管阻塞的幼儿的sGaw。
