Tantichaiyakul Pavana, Preutthipan Aroonwan
Division of Pediatrics, Banpong Hospital, Ratchaburi, Thailand.
J Med Assoc Thai. 2010 May;93(5):541-9.
International asthma guideline recommends inhaled corticosteroids therapy for children of all ages as the first controller. However, in some less developed parts of the world, ketotifen, an old inexpensive medicine with antihistaminic and anti-allergic reactions, has been found to be the most favored prophylactic agents.
To compare the efficacy and safety of ketotifen and inhaled budesonide in asthmatic children aged 8 months to 14 years at Banpong Hospital, located 80 km south from Bangkok.
Children who had been admitted with acute asthmatic attack in 2008 at Banpong Hospital and had > 3 episodes of wheeze with good response to nebulized bronchodilators were randomized into two groups. Ketotifen group (n = 16) were given oral ketotifen 0.5 mg or 1 mg twice daily depending on age. Budesonide group (n = 14) were given as inhaled budesonide 200 microg (MDI) twice daily. Caregivers recorded children's asthmatic symptoms and nebulized treatments in diaries every day. The enrolled children received these two treatment regimens and were followed up for 26 weeks.
Number of ER visits decreased significantly after both treatments (p < 0.005). The percentage of children with reduction in ER visits was comparable between ketotifen and budesonide (p = 0.16). Ketotifen group also demonstrated a reduction in days of hospital stay (p < 0.05). Budesonide treatment resulted in more symptom-free days (p < 0.05). Both medications were well tolerated and safe. The only demonstrated side effect of ketotifen was weight gain. The growth rate in height for both groups did not differ.
Both ketotifen and inhaled budesonide are effective, safe, and well-tolerated in the prevention of asthma exacerbation in children particularly in the country with limited resource.
国际哮喘指南推荐，吸入性糖皮质激素疗法适用于各年龄段儿童，作为首选控制药物。然而，在世界上一些欠发达地区，酮替芬，一种具有抗组胺和抗过敏反应的老药且价格低廉，已被发现是最受青睐的预防药物。
在距离曼谷以南80公里的挽蓬医院，比较酮替芬和吸入用布地奈德对8个月至14岁哮喘儿童的疗效和安全性。
2008年在挽蓬医院因急性哮喘发作入院、喘息发作超过3次且对雾化支气管扩张剂反应良好的儿童被随机分为两组。酮替芬组（n = 16）根据年龄每日两次口服0.5毫克或1毫克酮替芬。布地奈德组（n = 14）每日两次吸入200微克布地奈德（定量气雾剂）。护理人员每天在日记中记录儿童的哮喘症状和雾化治疗情况。入选儿童接受这两种治疗方案，并随访26周。
两种治疗后急诊就诊次数均显著减少（p < 0.005）。酮替芬组和布地奈德组急诊就诊次数减少的儿童百分比相当（p = 0.16）。酮替芬组住院天数也有所减少（p < 0.05）。布地奈德治疗导致无症状天数更多（p < 0.05）。两种药物耐受性良好且安全。酮替芬唯一显示的副作用是体重增加。两组身高生长速率无差异。
酮替芬和吸入用布地奈德在预防儿童哮喘发作方面均有效、安全且耐受性良好，尤其是在资源有限的国家。
