Dept of Respiratory Paediatrics, Royal Brompton Hospital, London SW3 6NP, UK.
Eur Respir J. 2009 Nov;34(5):1052-9. doi: 10.1183/09031936.00186508. Epub 2009 Jun 18.
This study describes the clinical characteristics and corticosteroid responsiveness of children with difficult asthma (DA). We hypothesised that complete corticosteroid responsiveness (defined as improved symptoms, normal spirometry, normal exhaled nitric oxide fraction (F(eNO)) and no bronchodilator responsiveness (BDR <12%)) is uncommon in paediatric DA. We report on 102 children, mean+/-sd age 11.6+/-2.8 yrs, with DA in a cross-sectional study. 89 children underwent spirometry, BDR and F(eNO) before and after 2 weeks of systemic corticosteroids (corticosteroid response study). Bronchoscopy was performed after the corticosteroid trial. Of the 102 patients in the cross-sectional study, 88 (86%) were atopic, 60 (59%) were male and 52 (51%) had additional or alternative diagnoses. Out of the 81 patients in the corticosteroid response study, nine (11%) were complete responders. Of the 75 patients with symptom data available, 37 (49%) responded symptomatically, which was less likely if there were smokers in the home (OR 0.31, 95% CI 0.02-0.82). Of the 75 patients with available spirometry data, 35 (46%) had normal spirometry, with associations being BAL eosinophilia (OR 5.43, 95% CI 1.13-26.07) and high baseline forced expiratory volume in 1 s (FEV(1)) (OR 1.08, 95% CI 1.02-1.12). Of these 75 patients, BDR data were available in 64, of whom 36 (56%) had <12% BDR. F(eNO) data was available in 70 patients, of whom 53 (75%) had normal F(eNO). Airflow limitation data was available in 75 patients, of whom 17 (26%) had persistent airflow limitation, which was associated with low baseline FEV(1) (OR 0.93, 95% CI 0.90-0.97). Only 11% of DA children exhibited complete corticosteroid responsiveness. The rarity of complete corticosteroid responsiveness suggests alternative therapies are needed for children with DA.
这项研究描述了儿童难治性哮喘(DA)的临床特征和皮质类固醇反应性。我们假设完全皮质类固醇反应性(定义为症状改善、肺功能正常、呼气一氧化氮分数(F(eNO))正常和无支气管扩张剂反应性(BDR<12%))在儿科 DA 中不常见。我们报告了一项横断面研究中的 102 名儿童,平均年龄为 11.6+/-2.8 岁。89 名儿童在接受 2 周全身皮质类固醇治疗前后进行了肺功能、BDR 和 F(eNO)检查(皮质类固醇反应研究)。皮质类固醇试验后进行支气管镜检查。在横断面研究的 102 名患者中,88 名(86%)为特应性,60 名(59%)为男性,52 名(51%)有其他或替代诊断。在皮质类固醇反应研究的 81 名患者中,9 名(11%)为完全反应者。在有症状数据的 75 名患者中,37 名(49%)症状得到缓解,如果家中有吸烟者,症状缓解的可能性较小(OR 0.31,95%CI 0.02-0.82)。在有可用肺功能数据的 75 名患者中,35 名(46%)肺功能正常,与 BAL 嗜酸性粒细胞增多(OR 5.43,95%CI 1.13-26.07)和高基线用力呼气量 1 秒(FEV(1))(OR 1.08,95%CI 1.02-1.12)相关。在这 75 名患者中,64 名患者有 BDR 数据,其中 36 名(56%)BDR<12%。70 名患者有 F(eNO)数据,其中 53 名(75%)F(eNO)正常。75 名患者中有气流受限数据,其中 17 名(26%)持续存在气流受限,与低基线 FEV(1)相关(OR 0.93,95%CI 0.90-0.97)。只有 11%的 DA 儿童表现出完全的皮质类固醇反应性。完全皮质类固醇反应性的罕见性表明需要为 DA 儿童提供替代治疗。