König P, Shaffer J
Department of Child Health, University of Missouri Health Sciences Center, Columbia 65212, USA.
J Allergy Clin Immunol. 1996 Dec;98(6 Pt 1):1103-11. doi: 10.1016/s0091-6749(96)80198-9.
International guidelines classify childhood asthma as mild, moderate, and severe and recommend treatment with "as needed" bronchodilators, cromolyn sodium, and inhaled corticosteroids, respectively. Recently, some investigators proposed inhaled corticosteroids as first-line therapy to avoid possible irreversible airway obstruction. This article describes a retrospective study assessing the effect of the guidelines' approach on the long-term outcome of childhood asthma and the possible effect of delaying initiation of administration of corticosteroids.
A retrospective review was performed on the charts of 175 children, and an end-of-study questionnaire plus results of spirometry completed the data. The mean age at start of study was 6.5 years, and the children were followed up for 2.2 to 16.8 years (mean, 8.4 years). Treatments included bronchodilators as needed only (patients with mild asthma), cromolyn sodium (patients with moderate asthma), and inhaled corticosteroids (patients with severe asthma).
Frequency of symptoms, unscheduled doctors' visits, emergency department visits, hospitalizations, and missed school days decreased for the whole group. Statistically significant between-treatment differences favored both antiinflammatory therapies over as-needed bronchodilator treatment (cromolyn sodium: symptoms, p < 0.05; hospitalizations, p < 0.05; corticosteroids: emergency department visits, p < 0.05; hospitalizations, p < 0.05). Mean spirometry results improved, and the postbronchodilator values approached normal by study end. Assessed by treatment, spirometry decreased with bronchodilators but improved in patients treated with cromolyn sodium or inhaled corticosteroids. Delay in starting administration of cromolyn sodium had an unfavorable effect on clinical outcomes (p < 0.01) and spirometry (p < 0.05); delay in starting administration of corticosteroids did not.
Treatment with antiinflammatory drugs (cromolyn sodium or inhaled corticosteroids), but not as-needed bronchodilators alone, improves the long-term prognosis of asthma. It is possible that starting administration of nonsteroid antiinflammatory agents earlier than the present recommendations could further improve clinical outcomes, but prospective studies are needed.
国际指南将儿童哮喘分为轻度、中度和重度，并分别推荐使用“按需”支气管扩张剂、色甘酸钠和吸入性糖皮质激素进行治疗。最近，一些研究人员提议将吸入性糖皮质激素作为一线治疗方法，以避免可能出现的不可逆气道阻塞。本文描述了一项回顾性研究，评估该指南的治疗方法对儿童哮喘长期预后的影响以及延迟使用糖皮质激素的可能影响。
对175名儿童的病历进行回顾性分析，并通过研究结束时的问卷调查以及肺活量测定结果来完善数据。研究开始时的平均年龄为6.5岁，对这些儿童进行了2.2至16.8年的随访（平均8.4年）。治疗方法包括仅按需使用支气管扩张剂（轻度哮喘患者）、色甘酸钠（中度哮喘患者）和吸入性糖皮质激素（重度哮喘患者）。
整个组的症状频率、非计划就诊次数、急诊就诊次数、住院次数和缺课天数均有所减少。治疗组之间具有统计学意义的差异表明，两种抗炎治疗方法均优于按需使用支气管扩张剂治疗（色甘酸钠：症状，p<0.05；住院次数,p<0.05；糖皮质激素：急诊就诊次数，p<0.05；住院次数，p<0.05）。平均肺活量测定结果有所改善，到研究结束时，支气管扩张剂使用后的数值接近正常。按治疗方法评估，使用支气管扩张剂时肺活量测定值下降，但使用色甘酸钠或吸入性糖皮质激素治疗的患者肺活量测定值有所改善。延迟开始使用色甘酸钠对临床结局（p<0.01）和肺活量测定（p<0.05）有不利影响；延迟开始使用糖皮质激素则没有。
使用抗炎药物（色甘酸钠或吸入性糖皮质激素）治疗，而不是仅按需使用支气管扩张剂，可改善哮喘的长期预后。比目前建议更早开始使用非甾体抗炎药可能会进一步改善临床结局，但需要进行前瞻性研究。
