Zheng Shengkun, Yu Qiying, Zeng Xiangyan, Sun Wangming, Sun Yan, Li Mengrong
Department of Pediatrics, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, P.R. China.
Medicine (Baltimore). 2017 Sep;96(35):e7848. doi: 10.1097/MD.0000000000007848.
Asthma is a chronic inflammatory disease that requires adherence to both preventative and therapeutic interventions in disease management. Children with asthma are likely to discontinue inhaled corticosteroids (ICS), especially when symptoms are under control. We aimed to investigate the impact of ICS adherence in children whose symptoms were under control.The study is cohort study; 35 children with controlled asthma that had undergone 3 years of follow-up were included. Serum eosinophil count, serum total IgE (tIgE), and lung function (FEV1, FEV1/FVC, PEF, FEF20-75%, and PC20) were evaluated at the beginning and end of the follow-up.At baseline, patients in both the adherent and nonadherent groups were similar. After 3 years, the nonadherent group who had discontinued ICS had a decrease in FEV1 (P < .05), FEV1/FVC (P < .05), PEF (P < .05), and FEF20-75% (P < .05). The nonadherent group had no significant improvement in PC20 compared with their values at the beginning of the follow-up, whereas the adherent group had improvement in PC20. Furthermore, there was an increase in serum eosinophil (P < .001) and tIgE (P < .05) in the nonadherent compared with the adherent group.Despite good asthma control, airway hyperresponsiveness (AHR) was detected in a large proportion of children with asthma. ICS discontinuation affected lung function, serum eosinophil count, tIgE, and AHR. Adequate adherence is important in asthma management. The benefits of ICS and the influence of drug discontinuation despite good asthma control may encourage better adherence from patients.
哮喘是一种慢性炎症性疾病，在疾病管理中需要坚持预防和治疗干预措施。哮喘患儿很可能会停用吸入性糖皮质激素（ICS），尤其是在症状得到控制时。我们旨在研究ICS依从性对症状得到控制的儿童的影响。该研究为队列研究；纳入了35名哮喘得到控制且已接受3年随访的儿童。在随访开始和结束时评估血清嗜酸性粒细胞计数、血清总IgE（tIgE）和肺功能（FEV1、FEV1/FVC、PEF、FEF20 - 75%和PC20）。在基线时，依从组和不依从组的患者情况相似。3年后，停用ICS的不依从组的FEV1（P＜0.05）、FEV1/FVC（P＜0.05）、PEF（P＜0.05）和FEF20 - 75%（P＜0.05）均下降。与随访开始时的值相比，不依从组的PC20无显著改善，而依从组的PC20有所改善。此外，与依从组相比，不依从组的血清嗜酸性粒细胞（P＜0.001）和tIgE（P＜0.05）有所增加。尽管哮喘得到了良好控制，但仍有很大比例的哮喘儿童存在气道高反应性（AHR）。停用ICS会影响肺功能（FEV1、FEV1/FVC、PEF、FEF20 - 75%）、血清嗜酸性粒细胞计数、tIgE和AHR。在哮喘管理中，充分的依从性很重要。ICS的益处以及尽管哮喘控制良好但停药的影响可能会促使患者更好地坚持治疗。
