Díaz Ledo J, Busquets Monge R M, García-Algar O, Ramírez Sarmiento A, Orozco Levi M
Unidad de Neumología y Alergia Pediátrica, Servicio de Pediatría, Hospital del Mar, Barcelona, España.
An Pediatr (Barc). 2010 Jan;72(1):42-8. doi: 10.1016/j.anpedi.2009.09.015. Epub 2009 Nov 25.
Asthma is the most common chronic disease in children and adolescents. The intermittent mechanical overloads during crises can lead to functional changes in the respiratory muscles, which experience adaptation phenomena. This article attempts to evaluate the respiratory and peripheral muscle state in asthmatic children who receive inhaled corticoids, and to find out if there is an association between muscle function and respiratory function.
The study involved 12 children over 7-years old with asthma and treated with inhaled corticoids for at least 2 years at intermediate doses (budesonide >or=400 microg, or fluticasone >or=200 microg) and 7 healthy control children paired by age. The following were determined: forced spirometry, static lung volumes, airway resistance, maximum inspiratory and expiratory pressures, peripheral musculo-skeletal function, and body composition using bioimpedance measurements.
The anthropometric, nutritional variables and peripheral muscle function were similar in both groups. The asthmatic children showed signs of air trapping, lung hyperinflation, and higher maximum inspiratory pressure values.
No evidence was found that continuous high doses of inhaled steroids lead to a deterioration in respiratory or peripheral muscle function in asthmatic children. On the other hand, signs were found of respiratory muscle adaptation to the long-term overload of persistent asthma. The so-called "training effect" seems to be limited only to the inspiratory muscles.
哮喘是儿童和青少年中最常见的慢性疾病。发作期间的间歇性机械负荷可导致呼吸肌功能改变，并出现适应性现象。本文旨在评估接受吸入性皮质激素治疗的哮喘儿童的呼吸和外周肌肉状态，并探究肌肉功能与呼吸功能之间是否存在关联。
该研究纳入了12名7岁以上的哮喘儿童，他们接受中等剂量（布地奈德≥400微克，或氟替卡松≥200微克）吸入性皮质激素治疗至少2年，以及7名年龄匹配的健康对照儿童。测定了以下指标：用力肺活量、静态肺容量、气道阻力、最大吸气和呼气压力、外周肌肉骨骼功能以及使用生物电阻抗测量法测定的身体成分。
两组的人体测量学、营养变量和外周肌肉功能相似。哮喘儿童表现出气体潴留、肺过度充气的迹象以及更高的最大吸气压力值。
未发现有证据表明持续高剂量吸入性类固醇会导致哮喘儿童呼吸或外周肌肉功能恶化。另一方面，发现了呼吸肌对持续性哮喘长期负荷产生适应的迹象。所谓的“训练效应”似乎仅局限于吸气肌。
