Unité de Pneumologie-Allergologie Pédiatrique, Clinique de Pédiatrie Jeanne de Flandre, CHRU, 59037 Lille cedex, France.
Eur Respir J. 2012 Feb;39(2):290-6. doi: 10.1183/09031936.00185310. Epub 2011 Aug 18.
Some children with severe asthma develop frequent exacerbations despite intensive treatment. We sought to assess the outcome (severe exacerbations and healthcare use, lung function, quality of life and maintenance treatment) of a strategy based on daily home spirometry with teletransmission to an expert medical centre and whether it differs from that of a conventional strategy. 50 children with severe uncontrolled asthma were enrolled in a 12-month prospective study and were randomised into two groups: 1) treatment managed with daily home spirometry and medical feedback (HM) and 2) conventional treatment (CT). The children's mean age was 10.9 yrs (95% confidence interval 10.2-11.6). 44 children completed the study (21 in the HM group and 23 in the CT group). The median number of severe exacerbations per patient was 2.0 (interquartile range 1.0-4.0) in the HM group and 3.0 (1.0-4.0) in the CT group (p=0.38 with adjustment for age). There were no significant differences between the two groups for unscheduled visits (HM 5.0 (3.0-7.0), CT 3.0 (2.0-7.0); p=0.30), lung function (pre-β(2)-agonist forced expiratory volume in 1 s (FEV(1)) p=0.13), Paediatric Asthma Quality of Life Questionnaire scores (p=0.61) and median daily dose of inhaled corticosteroids (p=0.86). A treatment strategy based on daily FEV(1) monitoring with medical feedback did not reduce severe asthma exacerbations.
一些患有严重哮喘的儿童尽管接受了强化治疗，但仍会频繁发作。我们评估了一种基于每日家庭肺量计检测并将结果远程传输到医学中心，然后由专家进行医疗反馈的策略的治疗结果（严重发作次数和医疗保健的使用、肺功能、生活质量和维持治疗），并将其与常规策略进行比较。我们纳入了 50 例患有严重未控制哮喘的儿童进行了一项为期 12 个月的前瞻性研究，并将他们随机分为两组：1）每日家庭肺量计检测和医学反馈治疗组（HM 组）；2）常规治疗组（CT 组）。儿童的平均年龄为 10.9 岁（95%置信区间为 10.2-11.6）。44 例儿童完成了研究（HM 组 21 例，CT 组 23 例）。HM 组中每名患者的严重发作中位数为 2.0（1.0-4.0），CT 组为 3.0（1.0-4.0）（校正年龄后 p=0.38）。两组之间的非计划性就诊次数（HM 组 5.0（3.0-7.0），CT 组 3.0（2.0-7.0）；p=0.30）、肺功能（用药前β2-激动剂 1 秒用力呼气容积（FEV1）（p=0.13））、儿童哮喘生活质量问卷评分（p=0.61）和吸入皮质激素的中位日剂量（p=0.86）均无显著差异。基于每日 FEV1 监测和医学反馈的治疗策略并未减少严重哮喘发作的次数。
