中重度持续性哮喘儿童吸入ICS减量停药的随访研究  

The follow-up study of stepping down inhaled corticosteroids in childhood asthma

作　　者：孙丽红[1] 陈爱欢[1] 张艺[2] 肖雪葵[1] 余颖华[1] 

机构地区：[1]广州医学院第一附属医院,广州呼吸疾病研究所,广东广州510120 [2]中山大学附属第一医院东山院区过敏反应科,广东广州510120

出　　处：《中国热带医学》2009年第8期1512-1513,1527,共3页China Tropical Medicine

摘　　要：目的观察中重度持续性哮喘儿童吸入糖皮质激素（ICS）的疗程，哮喘达到良好控制后ICS成功减停的可行性。方法将76例年龄（8．8±2．6）岁的中重度哮喘患儿，依年龄吸入布地奈德干粉剂起始剂量为4001μg／d或600μg/d达到哮喘控制3个月以上，ICS减少50％剂量维持治疗后，每3个月减少50-100μg，停药后进行24个月的随访。结果初始高剂量时间平均为5．7月（4～10月），总的疗程平均为26．4月（20～39月）。成功减停激素的患儿有62例（90％），其中51例（82.3％）控制良好，9例（14．5％）有轻度喘息发作用，2例（3．2％）病人反复发作。治疗后发生哮喘恶化事件及相关的急诊就医、缺课、住院的患儿比率均低于治疗前（x^2=58．899，73．255，94．891，4．279；P〈0．001或P〈0．05）。结论对于中高剂量ICS治疗的哮喘儿童达到控制并维持3个月以上，ICS减少50％用量，维持一定时间的治疗后大部分患儿激素均可以顺利的减停。Objective To explore the course of inhaled corticosteroids （ICS） in moderate to severe childhood asthma, assess the possibility of successful withdrawal of ICS following a good control. Methods There 84 children （5-12 years old） with moderate to severe asthma were allocated to receive budesenide dry power 400μg/d or 600μg/d, depending on the age,once achieved asthma control for a period,ICS reduced 50% to a maintenance level,later the dosage was reduced by 50-100txg at intervals of 3 months,then followed by 24 months. Results The initial period on a high dose was 5.7 months （4-10 months）,the mean total duration of treatment was 26.4 months （20-39 months）. of the 62 children who successfully withdrawaled,51 （82.3%） remained well, 9（ 14.5% ） had mild episodes of wheezing, 2 （3.2%） had troublesome recurreneeso Numbers （%） of patients with asthma exacerations and related events as visit to emergency department ,absece from school, admission to hospital are all lower than pretherapy （x^2=58.899,73.255,94.891,4.2799; P〈0.001 or P〈0.05）. Conclusion Children with asthma who require moderate to high dosage ICS once achieving good control for more than 3 months,ICS can be reduced by 50%. It is possible to withdraw ICS in a significant proportion asthmatic children who has been on a maintence dose for a considerable period.

关 键 词：儿童哮喘 吸入糖皮质激素 停药 

分 类 号：R562.25[医药卫生—呼吸系统]