Campusano L, Pastenes M, Fontecilla C, Escalona J, Salazar C, Castro-Rodriguez J A
Department of Pediatrics, Universidad de Antofagasta, Antofagasta, Chile.
Allergol Immunopathol (Madr). 2010 Jan-Feb;38(1):31-6. doi: 10.1016/j.aller.2009.09.001. Epub 2009 Oct 28.
The treatment in non-atopic young children with recurrent wheezing remains controversial.
The aim of the study was to compare the response of inhaled budesonide in atopic versus non-atopic infants/preschoolers with recurrent wheezing (more than three episodes in the last year or one episode per month in the last three months).
One hundred and seventy three infants/preschoolers (mean age 1.58+/-0.9 yrs) with recurrent wheezing without previous use of inhaled corticosteroids were enrolled and divided into two categories: atopics (eosinophils in peripheral blood > or =4%) and non-atopics (<4%). Both groups were treated with budesonide (200 mcg bid delivered by MDI and spacer) for three months. The primary outcome was the prevalence of wheezing exacerbation episodes at the end of the treatment.
Thirty-seven out of 173 (21.4%) were atopics and they were significantly younger, more frequently with a father with asthma, maternal grandparents with asthma and rhinitis, paternal and maternal grandparents with eczema, and higher number of wheezing episodes in the last year than non-atopics. At the end of the study, among those with good compliance (>70% of the weekly doses), the proportion of wheezing episodes were similar among atopics and non-atopics (57.7% vs. 44.1%, p=0.25, respectively); the number of exacerbations requiring emergency department (ED) visits and hospital admission were also similar.
Regular budesonide therapy may decrease the episodes of wheezing in infants/preschoolers with recurrent wheezing, independently of atopy.
非特应性复发性喘息幼儿的治疗仍存在争议。
本研究旨在比较吸入布地奈德对患有复发性喘息（过去一年发作超过三次或过去三个月每月发作一次）的特应性与非特应性婴儿/学龄前儿童的反应。
招募173名未使用过吸入性糖皮质激素的复发性喘息婴儿/学龄前儿童（平均年龄1.58±0.9岁），分为两类：特应性（外周血嗜酸性粒细胞≥4%）和非特应性（<4%）。两组均接受布地奈德治疗（通过定量吸入器和储雾罐每日两次吸入200μg），为期三个月。主要结局是治疗结束时喘息加重发作的发生率。
173名中有37名（21.4%）为特应性，他们明显比非特应性儿童年龄更小，父亲患哮喘、外祖父母患哮喘和鼻炎、祖父母患湿疹的情况更常见，且过去一年喘息发作次数更多。研究结束时，在依从性良好（每周剂量>70%）的儿童中，特应性和非特应性儿童的喘息发作比例相似（分别为57.7%和44.1%，p = 0.25）；需要急诊就诊和住院的加重发作次数也相似。
规律的布地奈德治疗可减少复发性喘息婴儿/学龄前儿童的喘息发作次数，与特应性无关。
