Division of Respiratory Diseases, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts 02115, USA.
Ann Allergy Asthma Immunol. 2010 Jan;104(1):30-5. doi: 10.1016/j.anai.2009.11.004.
Daily controller medication use is recommended for children with persistent asthma to achieve asthma control.
To examine patterns of inhaled corticosteroid (ICS) use and asthma control in an observational study of children and adolescents with mild-to-moderate asthma (the Childhood Asthma Management Program Continuation Study).
We assessed patterns of ICS use during a 12-month period (consistent, intermittent, and none) and asthma control (well controlled vs poorly controlled). Multivariate logistic regression examined the association between pattern of ICS use and asthma control.
Of 914 patients enrolled, 425 were recommended to continue receiving ICS therapy in the Childhood Asthma Management Program Continuation Study. Of these patients, 46% reported consistent ICS use and 20% reported no ICS use during year 1. By year 4, consistent ICS use decreased to 20%, whereas no ICS use increased to 57%; poorly controlled asthma was reported in 18% of encounters. In multivariate models controlling for age, sex, forced expiratory volume in 1 second, and asthma severity assessment, patients reporting consistent ICS use during a 12-month period were more likely to report poor asthma control (odds ratio, 1.6; 95% confidence interval, 1.2-2.1) compared with those reporting no ICS use.
In this observational study of children and adolescents with mild-to-moderate asthma, most did not report continued use of ICS. Patients recommended to continue receiving ICS therapy and reporting consistent ICS use were less likely to report well-controlled asthma even after controlling for markers of asthma severity. Although residual confounding by severity cannot be ruled out, many children and adolescents may not achieve well-controlled asthma despite consistent use of ICS.
推荐持续性哮喘患儿每日使用控制药物，以实现哮喘控制。
通过对轻中度哮喘儿童和青少年（儿童哮喘管理计划延续研究）进行观察性研究，检测吸入性皮质类固醇（ICS）使用模式与哮喘控制情况。
我们评估了 12 个月期间 ICS 使用模式（持续、间歇性和无）与哮喘控制（控制良好与控制不佳）情况。多变量逻辑回归分析了 ICS 使用模式与哮喘控制之间的关系。
在入组的 914 例患者中，425 例患者被推荐继续在儿童哮喘管理计划延续研究中接受 ICS 治疗。这些患者中，46%报告在第 1 年持续使用 ICS，20%报告在第 1 年未使用 ICS。到第 4 年，持续使用 ICS 的比例降至 20%，而不使用 ICS 的比例增至 57%；18%的就诊报告哮喘控制不佳。在多变量模型中，控制年龄、性别、1 秒用力呼气量和哮喘严重程度评估，在 12 个月期间报告持续使用 ICS 的患者报告哮喘控制不佳的可能性是未使用 ICS 患者的 1.6 倍（比值比，1.2-2.1）。
在这项对轻中度哮喘儿童和青少年的观察性研究中，大多数患者未报告继续使用 ICS。与未使用 ICS 的患者相比，被推荐继续接受 ICS 治疗且报告持续使用 ICS 的患者报告控制良好的哮喘的可能性更小，即使控制了哮喘严重程度的标志物也是如此。尽管不能排除严重程度的残余混杂因素，但许多儿童和青少年尽管持续使用 ICS，也可能无法达到控制良好的哮喘。
