Department of Respiration, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9th Jinsui Road, Guangzhou, 510623, China.
Institute of Human Virology, Zhongshan School of Medicine, Sun Yat-Sen University, Guangzhou, China.
World J Pediatr. 2017 Dec;13(6):560-565. doi: 10.1007/s12519-017-0065-y. Epub 2017 Oct 20.
Inhaled corticosteroids (ICSs) for treating asthma are controversial because of their negative effects on the growth of asthmatic children and without clearly defined withdrawal strategy. A 2-year ICS step-down and withdrawal strategy has been developed for asthmatic children receiving 3-year subcutaneous immunotherapy (SCIT).
Eleven children were included into the SCIT group and 13 children into the ICS group. ICSs were discontinued when children met the following criteria: requiring only 1 puffper day, with good control, for at least 6 months; having a forced expiratory volume in 1 second (FEV)/forced vital capacity ≥80%; and SCIT discontinued for ≥24 months. The main endpoints were the results of both the childhood asthma control test (C-CAT) and the methacholine bronchial provocation test.
In the SCIT group, all the 11 children had ICS discontinued, with one child developed asthma attack after pneumonia and received ICS again after completion of SCIT. In the ICS group, five children discontinued ICS and developed asthma attacks later and received ICS again; the other eight children developed severe symptoms during ICS step-down. Thus, the discontinuation of ICS was only achieved in the SCIT group. The dose of methacholine that caused a decrease of 20% in FEV continued to improve after discontinuation of ICS for the SCIT group and presented better results than the ICS group (P=0.050). After completion of SCIT, the C-CAT had improved significantly after 30 months of treatment compared with the ICS group (P<0.05).
In the present study, we developed a 2-year step-down and withdrawal strategy from ICSs strategy for allergic asthma children receiving SCIT; the strategy was efficacious and safe.
由于吸入性皮质类固醇（ICS）对哮喘患儿的生长有负面影响，且缺乏明确的停药策略，因此其在治疗哮喘方面存在争议。我们为接受 3 年皮下免疫治疗（SCIT）的哮喘儿童制定了 2 年 ICS 逐步减量和停药策略。
11 名儿童纳入 SCIT 组，13 名儿童纳入 ICS 组。当儿童符合以下标准时，停止使用 ICS：每天只需 1 吸，控制良好，至少 6 个月；第 1 秒用力呼气量（FEV）/用力肺活量（FVC）≥80%；且 SCIT 停药≥24 个月。主要终点是儿童哮喘控制测试（C-CAT）和乙酰甲胆碱支气管激发试验的结果。
在 SCIT 组中，所有 11 名儿童均停用了 ICS，其中 1 名儿童在肺炎后发生哮喘发作，在完成 SCIT 后再次使用 ICS。ICS 组中，5 名儿童停用 ICS 后发生哮喘发作，再次使用 ICS；另外 8 名儿童在 ICS 减量过程中出现严重症状。因此，只有 SCIT 组实现了 ICS 的停用。在停用 ICS 后，SCIT 组的乙酰甲胆碱导致 FEV 下降 20%的剂量持续改善，结果优于 ICS 组（P=0.050）。完成 SCIT 后，与 ICS 组相比，治疗 30 个月后 C-CAT 显著改善（P<0.05）。
在本研究中，我们为接受 SCIT 的过敏性哮喘儿童制定了 2 年的 ICS 逐步减量和停药策略；该策略是有效且安全的。
