Division of Respiratory Medicine, Alberta Children's Hospital, Calgary, Alberta, Canada.
Paediatr Drugs. 2011 Feb 1;13(1):11-7. doi: 10.2165/11533730-000000000-00000.
The treatment of children with asthma has historically relied upon expert opinion using data extrapolated from adult studies. Over the past few years, landmark studies have been completed providing healthcare professionals with evidence on which a reasonable approach can be made for children suffering from this common and serious disease. Asthmatic phenotype in children, unlike adults, tends to differ according to age, which must be taken into account as well as triggers, severity, and level of control. The care of the child with asthma is complex, but accumulating data have demonstrated that we are on the right path for optimizing control while reducing the burden of side effects. The newest Global Initiative for Asthma (GINA) guidelines, as well as recent updates from the landmark CAMP (Childhood Asthma Management Program) study and information from the PACT (Pediatric Asthma Control Trial) and budesonide/formoterol controller and reliever studies, along with recent comparisons of higher dose inhaled corticosteroids (ICS), and ICS/long-acting β(2)-adrenoceptor agonist (LABA) combination and leukotriene receptor antagonist (LTRA) therapies in children have clarified a few of the big questions in pediatric asthma. For children with asthma aged 5 years and older, the CAMP trial demonstrated that regular use of ICS reduces the frequency of symptoms; however, height was adversely affected and there is no evidence for altering the natural history of asthma. In patients aged 6 years and over whose asthma is uncontrolled on ICS alone, combination therapy with ICS and a LABA has been recently compared with the use of higher dose ICS and the addition of an LTRA in pediatric patients. The addition of a LABA statistically will be of most benefit; however, some children will have optimal control with doubling the baseline dose of ICS or addition of an LTRA. Use of budesonide/formoterol as a controller and reliever therapy extends the time to first exacerbation versus contemporary use of this medication in patients aged 4 years and older. Ciclesonide, a newer ICS, has demonstrated acceptable efficacy but has the added benefit of not affecting growth. Certainly, with mounting evidence, the care-map in pediatric asthma control is becoming clearer.
儿童哮喘的治疗一直依赖于专家意见，这些意见是利用从成人研究中推断的数据得出的。在过去的几年中，已经完成了一些具有里程碑意义的研究，为医疗保健专业人员提供了有关儿童常见严重疾病的合理治疗方法的证据。与成人不同，儿童哮喘表型往往因年龄而异，这必须与诱因、严重程度和控制水平一起考虑。儿童哮喘的护理很复杂，但不断积累的数据表明，我们正在优化控制的正确道路上，同时减少副作用的负担。最新的全球哮喘倡议 (GINA) 指南，以及最近更新的标志性 CAMP（儿童哮喘管理计划）研究信息，以及 PACT（儿科哮喘控制试验）和布地奈德/福莫特罗控制器和缓解剂研究的信息，以及最近比较高剂量吸入皮质类固醇（ICS）、ICS/长效β(2)-肾上腺素能受体激动剂（LABA）联合和白三烯受体拮抗剂（LTRA）治疗在儿童哮喘中的应用，澄清了儿童哮喘的一些重大问题。对于年龄在 5 岁及以上的哮喘儿童，CAMP 试验表明，常规使用 ICS 可降低症状发生频率；然而，身高受到不利影响，而且没有证据表明可以改变哮喘的自然病史。对于仅使用 ICS 控制不佳的 6 岁及以上患者，ICS 和 LABA 的联合治疗最近已与高剂量 ICS 的使用和儿科患者中 LTRA 的添加进行了比较。添加 LABA 统计上会有最大的益处；然而，一些儿童通过加倍 ICS 的基础剂量或添加 LTRA 将获得最佳控制。与 4 岁及以上患者中使用这种药物相比，使用布地奈德/福莫特罗作为控制器和缓解剂治疗可延长首次恶化的时间。新型 ICS 环索奈德已证明具有可接受的疗效，但具有不影响生长的额外益处。随着越来越多的证据，儿童哮喘控制的护理图变得更加清晰。
