Garrett J, Williams S, Wong C, Holdaway D
Department of Paediatrics and Child Health, Dunedin School of Medicine, University of Otago Medical School, New Zealand.
Arch Dis Child. 1998 Jul;79(1):12-7. doi: 10.1136/adc.79.1.12.
To investigate the efficacy of an increased dose of inhaled steroid used within the context of an asthma self management plan for treating exacerbations of asthma.
Randomised, double blind, placebo controlled, crossover trial.
Twenty eight children aged 6-14 years with asthma of mild to moderate severity were studied for six months. Eighteen pairs of exacerbations were available for analysis, during which subjects took an increased dose of inhaled steroids or continued on the same dose.
There was no significant difference between increasing inhaled steroids or placebo on morning or evening peak expiratory flow rates (PEFRs), diurnal peak flow variability, or symptom scores in the two weeks following an asthma exacerbation. Difference (95% confidence intervals) in baseline PEFR on days 1-3 were 3.4% (-3.5% to 10.4%) and -0.9% (-4.7% to 2.9%) for inhaled steroid and placebo, respectively. Spirometric function and the parents' opinion of the effectiveness of asthma medications at each exacerbation were also not significantly different between inhaled steroid or placebo.
This study suggests that increasing the dose of inhaled steroids at the onset of an exacerbation of asthma is ineffective and should not be included in asthma self management plans.
探讨在哮喘自我管理计划中增加吸入性类固醇剂量治疗哮喘急性加重的疗效。
随机、双盲、安慰剂对照、交叉试验。
对28名6 - 14岁轻度至中度哮喘患儿进行为期6个月的研究。有18对急性加重情况可供分析，在此期间，受试者增加吸入性类固醇剂量或维持原剂量。
在哮喘急性加重后的两周内，增加吸入性类固醇剂量组与安慰剂组在早晚呼气峰值流速（PEFR）、日峰值流速变异性或症状评分方面无显著差异。第1 - 3天基线PEFR的差异（95%置信区间），吸入性类固醇组为3.4%（-3.5%至10.4%），安慰剂组为-0.9%（-4.7%至2.9%）。在每次急性加重时，肺功能测定结果以及家长对哮喘药物疗效的评价在吸入性类固醇组和安慰剂组之间也无显著差异。
本研究表明，在哮喘急性加重开始时增加吸入性类固醇剂量无效，不应纳入哮喘自我管理计划。
