Department of National Heart and Lung Institute, Imperial College London, UK.
Department of Respiratory Paediatrics, Royal Brompton Hospital, London, UK.
Pediatr Pulmonol. 2020 Sep;55(9):2254-2260. doi: 10.1002/ppul.24943. Epub 2020 Jul 10.
Little is known about adherence to inhaled corticosteroids (ICS) in preschool children with troublesome wheeze. Children with aeroallergen senitization, or those reporting multiple trigger wheeze (MTW), are more likely to respond to ICS. We hypothesized that adherence to ICS and symptom control are only positively related in atopic children, or those reporting MTW. Patients aged 1 to 5 years with recurrent wheeze prescribed ICS were recruited from a tertiary respiratory clinic. Clinical phenotype and aeroallergen senitization were determined, and adherence assessed using an electronic monitoring device (Smartinhaler). Symptom control (test for respiratory and asthma control in kids [TRACK]), quality of life (PACQLQ), airway inflammation (offline exhaled nitric oxide) were assessed at baseline and follow-up. Forty-eight children (mean age 3.7 years; SD, 1.2) were monitored for a median of 112 (interquartile range [IQR], 91-126) days. At baseline n = 29 reported episodic viral wheeze and n = 19 reported MTW. Twenty-four out of 48 (50%) wheezers had suboptimal ICS adherence (<80%). Median adherence was 64% (IQR, 38-84). There was a significant increase in TRACK and PACQLQ in the group as a whole, unrelated to adherence. In subgroup analysis only atopic wheezers with moderate or good adherence ≥ 60% had a significant increase in TRACK. There was no relationship between clinical phenotype, and adherence or TRACK. In this pilot study, overall adherence to ICS was suboptimal and was positively related to symptom control in atopic wheezers only. Assessments of adherence are important in preschool troublesome wheezers before therapy escalation to help identify those with an ICS responsive phenotype.
关于学龄前有喘息症状的儿童使用吸入性皮质类固醇（ICS）的依从性知之甚少。对空气过敏原敏感，或报告多次触发喘息（MTW）的儿童，更有可能对 ICS 有反应。我们假设，ICS 的依从性和症状控制仅与特应性儿童或报告 MTW 的儿童相关。从三级呼吸诊所招募了年龄在 1 至 5 岁之间、因反复喘息而开具 ICS 处方的患者。通过电子监测设备（Smartinhaler）评估临床表型和空气过敏原致敏情况，并评估依从性。在基线和随访时评估症状控制（用于儿童的呼吸和哮喘控制测试[TRACK]）、生活质量（PACQLQ）、气道炎症（离线呼出的一氧化氮）。48 名儿童（平均年龄 3.7 岁；标准差，1.2）的中位监测时间为 112 天（四分位距[IQR]，91-126）。在基线时，29 名患儿报告偶发性病毒性喘息，19 名患儿报告 MTW。48 名喘息患儿中，24 名（50%）的 ICS 依从性不理想（<80%）。中位数依从性为 64%（IQR，38-84）。整体而言，TRACK 和 PACQLQ 均有显著增加，与依从性无关。在亚组分析中，仅中度或高度依从性（≥60%）的特应性喘息儿童 TRACK 有显著增加。临床表型与依从性或 TRACK 之间无相关性。在这项初步研究中，ICS 的总体依从性不理想，仅在特应性喘息儿童中，ICS 的依从性与症状控制呈正相关。在进行治疗升级之前，对学龄前有喘息症状的儿童进行依从性评估很重要，这有助于确定具有 ICS 反应表型的患者。
