Raju Muppala, Sagar Malvika, Bush Andrew, Quaye Eugene, Ghamande Shekhar, Malhotra Sonal, Arroliga Mercedes E
Department of Pediatrics, Baylor Research Institute, Temple, Texas.
Division of Pediatric Pulmonology, Department of Pediatrics, Baylor Scott and White McLane Children's Medical Center, Temple, Texas.
Proc (Bayl Univ Med Cent). 2023 Apr 27;36(4):448-452. doi: 10.1080/08998280.2023.2204522. eCollection 2023.
In children, nonadherence to inhaled corticosteroid (ICS) therapy leads to poor asthma control and complications.
We evaluated the benefit from initiation of ICS administration once daily at school. We retrospectively chose patients from our pediatric pulmonary clinic who had poorly controlled asthma and prescribed ICS daily. For the study period, we examined the number of corticosteroid courses, emergency room visits, hospital admissions, symptom history, and pulmonary function tests.
Thirty-four patients who satisfied the inclusion criteria began the intervention. Preintervention, there were a mean number of 2.6 oral corticosteroid courses compared to 2 courses in the year following intervention ( = 0.8). Postintervention emergency department visits decreased from a mean of 1.4 to 1.0 ( = 0.71), and hospital admissions decreased from 1.23 to 0.57 ( = 0.04). There was also a significant increase in forced expiratory volume in 1 second (1.69 vs 1.4 L/sec, = 0.02), a decrease in systemic steroid-free days in a year (96 vs 141 days, = 0.03), and an increase in symptom-free days postintervention (28 vs 26 days, = 0.325).
These findings suggest that ICS administration in schools may help reduce hospital admissions and improve lung function in patients with poorly controlled asthma.
在儿童中，不坚持吸入性糖皮质激素（ICS）治疗会导致哮喘控制不佳和并发症。
我们评估了在学校每天开始使用ICS的益处。我们回顾性地从我们的儿科肺病诊所中选择了哮喘控制不佳且每日开具ICS处方的患者。在研究期间，我们检查了糖皮质激素疗程的数量、急诊就诊次数、住院次数、症状史和肺功能测试。
34名符合纳入标准的患者开始了干预。干预前，口服糖皮质激素疗程的平均数量为2.6个，而干预后一年为2个疗程（P = 0.8）。干预后急诊就诊次数从平均1.4次降至1.0次（P = 0.71），住院次数从1.23次降至0.57次（P = 0.04）。一秒用力呼气容积也有显著增加（1.69对1.4升/秒，P = 0.02），一年内无全身使用类固醇的天数减少（96对141天，P = 0.03），干预后无症状天数增加（28对26天，P = 0.325）。
这些发现表明，在学校使用ICS可能有助于减少哮喘控制不佳患者的住院次数并改善肺功能。
