Kolding Hospital, Kolding, Denmark.
Pediatr Pulmonol. 2011 Dec;46(12):1182-8. doi: 10.1002/ppul.21499. Epub 2011 Jul 12.
The aim of asthma management is to achieve and maintain clinical control. Control data for children is sparse.
This analysis evaluated factors associated with not achieving well-controlled (WC) asthma using data from a study in 548 children with uncontrolled asthma.
Post hoc analysis of factors affecting the probability of not achieving WC asthma in children receiving salmeterol/fluticasone propionate 50/100 µg bd (SFC) or montelukast 5 mg od (MON), included: reasons for patients failing the asthma control criteria; achievement of overall asthma control; time course of improvement in individual outcomes and composite score; factors associated with not achieving WC asthma.
The proportion of patients failing individual control criteria at baseline was: β2-agonist rescue use: 96%, peak expiratory flow (PEF): 91%, symptoms: 78%, and night-time awakenings: 66%. Most patients failed the composite control score for more than one reason with 482 (99%), 387 (80%), and 249 (52%) failing 2, 3, or 4 control criteria, respectively. Overall asthma control was achieved by 166 (59%) patients in the SFC group and 96 (36%) in the MON group (P < 0.001). Time course of control differed between individual control components with symptoms responding most rapidly and PEF most slowly. Factors significantly influencing the probability of not achieving WC asthma were treatment with MON, country, and night-time awakenings at baseline, treatment being the most important.
Different outcomes improve at different rates. Assessment of one or a few outcomes over-estimates the level of asthma control. An overall composite score in combination with the proportion of patients failing on three or more criteria seemed to most accurately reflect the level of control. Compared with SFC treatment, MON was three times less likely to result in good asthma control.
哮喘管理的目标是实现并维持临床控制。儿童的控制数据较为缺乏。
本分析使用一项纳入 548 例未控制哮喘患儿的研究数据，评估导致患儿无法达到良好控制（WC）哮喘的相关因素。
对影响沙美特罗/氟替卡松丙酸酯 50/100μg 每日 2 次（SFC）或孟鲁司特 5mg 每日 1 次（MON）治疗患儿无法达到 WC 哮喘的相关因素进行事后分析，包括：患儿无法达到哮喘控制标准的原因；整体哮喘控制的实现；各个结局和综合评分改善的时间过程；无法达到 WC 哮喘的相关因素。
基线时存在以下单项控制标准失败的患者比例：β2 激动剂救急使用：96%，呼气峰流速（PEF）：91%，症状：78%，夜间觉醒：66%。大多数患者因多个原因无法达到综合控制评分，其中 482 例（99%）、387 例（80%）和 249 例（52%）分别存在 2、3 或 4 项控制标准失败。SFC 组中 166 例（59%）和 MON 组中 96 例（36%）患者实现了整体哮喘控制（P<0.001）。不同的控制指标达到控制的时间过程存在差异，其中症状改善最快，PEF 最慢。显著影响无法达到 WC 哮喘概率的因素包括使用 MON 治疗、国家和基线时的夜间觉醒，其中治疗是最重要的因素。
不同的结局改善速度不同。仅评估一个或几个结局会高估哮喘控制水平。整体综合评分结合存在 3 项或更多标准失败的患者比例，似乎能更准确地反映控制水平。与 SFC 治疗相比，MON 治疗达到良好哮喘控制的可能性低 3 倍。
