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[中国儿童慢性咳嗽治疗的现状]

[Current status of chronic cough treatment in Chinese children].

出版信息

Zhonghua Er Ke Za Zhi. 2014 Mar;52(3):163-71.


DOI:
PMID:24824384
Abstract

OBJECTIVE: To comprehensively understand the current situation of the treatment of chronic cough in Chinese children and provide evidence for a reasonable standard therapy. METHOD: According to the 2008 Guideline of diagnosis and treatment of chronic cough in children that were formulated by The Subspecialty Group of Respiratory Diseases, the Society of Pediatrics, Chinese Medical Association and the Editorial Board of Chinese Journal of Pediatrics, the questionnaire of the cause of chronic cough in children was designed and 29 hospitals in 19 provinces, municipalities and autonomous regions were enrolled. Cases with chronic cough completed 3-month follow-up during May 2009 to April 2010 and information about drug treatment was collected. All data were input through Epidata 3.0 and SPSS19.0 software for statistical analysis. RESULT: Totally 4 529 cases were eligible (the passing rate is 98.8%). The leading three causes were cough variant asthma (CVA), upper airway cough syndrome (UACS) and post-infectious cough (PIC). The drug treatment was given to 3 537 cases (77.2%) at the first visit, and 1 044 cases (22.8%) were not given the treatment but were followed up for observation. In the follow-up period 2 524 cases adhered to medication (55.1%), 2 057 cases (44.9%) failed to adhere to treatment. The leading three medications in CVA patients was leukotriene receptor antagonists (81.68%), antihistamines (50.53%) and beta 2 agonists (37.77%). Follow-up showed that the use of inhaled corticosteroids (ICS) was on the rise and by the third month it was listed the second (10.74%). No significant difference (P = 0.092> 0.05) was found among the the effect of drugs used alone but there was significant difference among combinations (P = 0.006). Beta 2 agonists play a special role in the diagnosis and treatment of CVA. In UACS children, 49.80% cases used antimicrobial agents at first visit. Follow-up showed rapid decrease of antimicrobial usage and ICS use increased to the second position. Antihistamines and leukotriene combined with inhaled corticosteroids scheme had the best effect, 61.35% of PIC children were already given antimicrobial drugs before enrollment, compared with CVA (P = 0.000 1) and the utilization rate declined with a clear diagnosis. The effects of beta lactams and macrolides had no significant difference (P = 0.052). CONCLUSION: The choices of treatment for chronic cough in Chinese children are diverse, which is related to overlapping in etiology, diagnosis and the regional drug sources and habits in use of drugs. Currently, leukotriene receptor antagonists are at the first place in children with chronic cough medicine, but its effect was not significantly different from those of beta 2 agonists, antihistamines monotherapy. ICS has not been widely recognized in the treatment of children with chronic cough, even in the CVA. Rational use of antimicrobial agents has been improved. Pediatricians' understanding of chronic cough is being improved. We emphasize the principle of watching, waiting and follow-up in children with chronic cough. Effect on the determination of some CVA patients 1 to 3 months follow-up period is still too inadequate and may be considered appropriate to extend, while cases of multiple etiologies need to extend more observation and waiting time.

摘要

目的:全面了解我国儿童慢性咳嗽的治疗现状,为制定合理规范的治疗方案提供依据。 方法:参照中华医学会儿科学分会呼吸学组、《中华儿科杂志》编辑委员会制定的《儿童慢性咳嗽诊断与治疗指南(2008年版)》,设计儿童慢性咳嗽病因调查问卷,选取全国19个省、直辖市、自治区的29家医院为研究对象。对慢性咳嗽患儿进行为期3个月的随访(2009年5月至2010年4月),收集药物治疗情况。所有数据采用Epidata 3.0录入,SPSS19.0软件进行统计分析。 结果:共纳入符合标准病例4 529例(合格率98.8%)。慢性咳嗽病因前三位依次为咳嗽变异性哮喘(CVA)、上气道咳嗽综合征(UACS)和感染后咳嗽(PIC)。初诊时3 537例(77.2%)患儿接受了药物治疗,1 044例(22.8%)未用药,予以随访观察。随访期间,2 524例(55.1%)患儿坚持用药,2 057例(44.9%)未坚持治疗。CVA患儿使用的前三位药物依次为白三烯受体拮抗剂(81.68%)、抗组胺药(50.53%)和β2受体激动剂(37.77%)。随访显示吸入性糖皮质激素(ICS)使用呈上升趋势,至第3个月升至第二位(10.74%)。单药治疗效果差异无统计学意义(P = 0.092>0.05),联合用药效果差异有统计学意义(P = 0.006)。β2受体激动剂在CVA诊断和治疗中发挥特殊作用。UACS患儿初诊时抗菌药物使用率49.80%,随访显示抗菌药物使用率迅速下降,ICS升至第二位。抗组胺药联合白三烯及吸入性糖皮质激素方案效果最佳。PIC患儿61.35%入院前已使用抗菌药物,与CVA比较差异有统计学意义(P = 0.000 1),明确诊断后使用率下降。β-内酰胺类与大环内酯类抗菌药物疗效差异无统计学意义(P = 0.052)。 结论:我国儿童慢性咳嗽治疗选择多样,与病因重叠、诊断及地区药物来源和用药习惯有关。目前,白三烯受体拮抗剂在儿童慢性咳嗽用药中居首位,但与β2受体激动剂、抗组胺药单药治疗效果差异无统计学意义。ICS在儿童慢性咳嗽治疗中未得到广泛认可,即使在CVA中。抗菌药物合理使用率有所提高,儿科医师对慢性咳嗽的认识正在提高。强调对慢性咳嗽患儿进行观察、等待和随访的原则。部分CVA患儿1~3个月随访期判断疗效仍显不足,可考虑适当延长,对多种病因患儿需延长更多观察等待时间。

相似文献

[1]
[Current status of chronic cough treatment in Chinese children].

Zhonghua Er Ke Za Zhi. 2014-3

[2]
[Prospective multicenter clinical study on the causes constituents ratio of chronic cough in Chinese children].

Zhonghua Er Ke Za Zhi. 2012-2

[3]
Retrospective, observational study of different medication regimens and outcome in children with cough variant asthma.

Immun Inflamm Dis. 2024-8

[4]
Eosinophilic airway disorders associated with chronic cough.

Pulm Pharmacol Ther. 2009-4

[5]
[Proportion of incidence of etiological agents in children with non-specific chronic cough in Chongqing: a follow-up study].

Zhonghua Er Ke Za Zhi. 2010-6

[6]
Comparable effect of a leukotriene receptor antagonist and long-acting beta₂-adrenergic agonist in cough variant asthma.

Allergy Asthma Proc. 2010

[7]
Guideline for the management of chronic asthma in children--2000 update. Allergy Society of South Africa Working Group.

S Afr Med J. 2000-5

[8]
[Pathophysiology, diagnosis and treatment of cough variant asthma].

Rinsho Byori. 2014-5

[9]
Initial step-up treatment changes in asthmatic children already prescribed inhaled corticosteroids: a historical cohort study.

NPJ Prim Care Respir Med. 2015-6-11

[10]
[Eosinophilic airway diseases presenting with isolated cough except for asthma].

Nihon Rinsho. 2001-10

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