必酮碟,喘宁碟防治小儿哮喘的疗效观察：附65例报告

对９５例中、重度哮喘患儿，分别用必酮碟、喘宁碟吸入，和传统间竭方法治疗，经１－３年随访结果，治疗组疗效显著优于对照组。表明小儿哮喘缓解期持续吸入小剂量的二丙酸培氯松－必酮碟，是当今理想的防治哮喘发作措施。     

普米克治疗儿童哮喘疗效观察

本文将 1995年 5月～ 1999年 5月 2 5 4例哮喘患儿随机分为观察组 12 6例 ,对照组 12 8例。均以普米克、喘康速吸入为主 ,同时采用综合措施 ,对危重症加用喘乐宁水溶液雾化吸入 ,静脉用皮质激素、氨茶碱、吸氧等治疗。症状缓解后观察组继续用喘康速 (按需吸入 )、普米克 3～ 6个月 ,完全缓解后小剂量维持 1～ 2年后渐停药。对照组未用普米克维持。随访观察疗效、细胞因子水平及峰速值 (ＰＥＦ)变化。随访观察组 73例 ,对照组 6 8例。观察组在咳嗽、喘、肺内哮鸣音等方面控制明显优于对照组 ,疗效显著 (Ｐ <0 .0 1) ;细胞因子(ＩＬ 2、ＩＬ 8…     

小剂量茶碱缓释片配合低剂量皮质激素吸入防治儿童哮喘疗效观察

吸入皮质激素是目前治疗哮喘最常用的方法 ,但有关皮质激素对哮喘儿童下丘脑 -垂体 -肾上腺轴 (HPAA)功能的影响尚无定论 ,已有人对常规剂量 (400μg/d)的二丙酸倍氯松 (BDP)长期吸入安全性提出质疑[1,2]。近年来 ,随着对茶碱药理作用的新认识 [3] ,更多的人开始重新评价其在哮喘防治中的作用 [4,5]。目前国内相关报道多为急性期的治疗 [6,7],尚未见长期用药的研究报道。我们从1998年底开始用茶碱缓释片口服配合低剂量皮质激素BDP吸入防治儿童中度哮喘 ,观察患儿用药2～3年的病情变化 ,现将结果报告如下。资料与方法一、病例选择及药物…     

皮质激素吸入疗法防治小儿哮喘的进展

皮质激素吸入疗法是目前防治小儿哮喘的最有效方法。近年来供吸入的倍氯米松、布地奈德、氟替卡松等具有疗效确切、副作用小的特点。潜在性不良反应与剂量及吸入技术有关。焦点在于有合适的指征及吸入皮质激素的治疗方法。     

皮质激素吸入疗法防治小儿哮喘的进展

皮质激素吸入疗法是目前防治小儿哮喘的最有效方法，近年来供吸入的倍氯米松，布地奈德，氟替卡松等具有疗效确切，副作用小的特点，潜在性不良反应与剂量及吸入技术有关，焦点在于有合适的指征及吸入皮质激素的治疗方法。     

舒利迭治疗支气管哮喘疗效观察

目的探讨舒利迭治疗中度支气管哮喘的临床疗效。方法回顾性分析舒利迭治疗中度哮喘发作患儿52例(治疗组),与辅舒酮(FP) 万托林吸入治疗30例对照(对照组),评价丽组临床疗效;治疗组中A1组(37例)按常规降级治疗,A2 组(15例)尝试缩短巩固治疗时间,提前进入缓解期,比较A1、A2两组控制发作的情况。结果治疗组与对照组临床控制率有显著差异(P<0.05);A1、A2组清晨呼气峰流速(PEF)1-2周内恢复正常(≥80%预计值)的比例无差异(P>0.05),1,5-2.5 个月到达缓解期的比例无差异(P>0.05)。结论吸入舒利迭治疗哮喘中度发作疗效优于吸入FP 万托林;吸入舒利迭可使中度发作患儿提前降级,较快到达缓解期,进入维持治疗阶段。     

小剂量肝素超声雾化吸入佐治毛细支气管炎35例

为探讨小剂量肝素超声雾化吸入治疗小儿毛细支气管炎的疗效 ,选择 6 6例毛细支气管炎患儿 ,随机分成治疗组 35例与对照组 31例 ,治疗组加用肝素超声雾化吸入。结果治疗组显效 2 5例 (占 71.4 % ) ,总有效率 97.1% ,人均住院日6 .85± 2 .1ｄ ,与对照组相比症状、体征完全消失的时间明显缩短 ,统计学处理差异显著。故认为小剂量肝素雾化吸入有效、安全 ,副作用小 ,可做为治疗小儿毛细支气管炎的辅助方法小剂量肝素超声雾化吸入佐治毛细支气管炎35例$辽宁省鞍山市妇幼保健所!114001@杨素芹…     

普米克令舒与博利康尼雾化液吸入治疗小儿哮喘临床疗效观察

目的观察普米克令舒与博利康尼雾化液吸入治疗小儿哮喘的临床疗效。方法将2006-09～2007-05收治的小儿哮喘50例随机分为3组。A组予生理盐水20mL加地塞米松2mg,超声雾化吸入15min;B组:生理盐水2mL加普米克令舒1mL(含布地奈德0.5mg)、博利康尼雾化液1mL(2.5mg),氧驱动雾化吸入10min;C组静滴氨茶碱每次3～5mg/kg,加用氢化可的松琥珀酸钠每次5.0mg/kg,同时配合吸氧。观察各组临床症状改善情况。结果各组临床症状有效率为:A组21.4%(3/14)、B组85.0%(17/20)、C组:81.3%(13/16)。结论普米克令舒联合博利康尼雾化吸入治疗小儿哮喘具有疗效好、用量少、副作用小、安全高效等优点。     

辅舒酮治疗儿童哮喘疗效观察

目的 观察新一代的吸入皮质激素辅舒酮对支气管哮喘儿的疗效。方法 在广西南宁的二个医院哮喘专科门诊观察80例哮喘儿使用新一代的吸入激素辅舒酮的疗效，并与二丙酸倍氯米松气雾剂对照。结果 两组病人的临床疗效评价经秩和检验有显著性差异（U＝2．4508，P＜0．05），辅舒酮组优于对照组；两组病的肺功能均有改善（P＜0．0001），但治疗组优于对照组（P＜0．001）。结论 辅舒酮为新一代的吸入激素药物，具有抗炎强，副作用少等特点，近期疗效显著，优于二丙酸倍氯米松气雾剂。     

吸入丙酸倍氯米松治疗婴幼儿哮喘的疗效观察

目的进一步了解吸入皮质激素对婴幼儿哮喘的治疗作用、副作用等问题.方法对170例1～3岁的轻中重度婴幼儿哮喘患儿,随机分成两组.治疗组根据病情的严重程度用面罩型筒式储雾罐吸入丙酸倍氯米松250～750μg/d;对照组不用吸入激素,只给予酮替芬等预防性治疗.结果治疗组患儿发作次数、咳嗽、喘息天数均较未经吸入治疗患儿少,并未发现明显副作用.结论各种严重程度的婴幼儿哮喘,借助面罩型储雾罐吸入皮质激素每日250～750μg均能收到较好疗效,而且安全.     

尘螨标准化免疫治疗85例哮喘儿童疗效相关指标分析

目的 观察哮喘特异性免疫治疗(Specific immunotherapy,SIT)过程中变应原注射时间、变应原累积注射量及糖皮质激素吸入剂量、最高呼气流量、总IgE、螨特异性IgE等的变化.方法 根据纳入标准选择2005年2月-2008年6月我院哮喘免疫治疗中心就诊的过敏性哮喘患儿,进行同期对照回顾性分析,其中治疗组接受尘螨标准化变应原特异性免疫治疗,以每4次变应原注射为观察点,历时3.4年,观察治疗时间、变应原累积注射量、糖皮质激素吸入量、最高呼气流量变化、总IgE和螨特异性IgE变化,对照组仅行药物治疗,比较两组糖皮质激素吸入量及哮喘发作情况,并在SIT结束时评估疗效.结果 SIT组85例,男45例,女40例,年龄(7.6±1.4)岁,对照组病例50例,单纯药物治疗,男28例,女22例,年龄(7.7±1.5)岁.SIT第20次注射、治疗(38.7±2.4)周时,变应原累积注射量达(69.7±4.8)μg,糖皮质激素吸入量明显少于对照组(t=2.359,P＜0.05);SIT组最高呼气流量较治疗前升高,有统计学意义(F=7.874,P＜0.05);SIT前后总IgE变化无统计学意义(t=0.313,P＞0.05),螨特异性IgE变化无统计学意义(tDerp=0.517,tDerf=0.717,P＞0.05);SIT组疗程结束时患儿家长对病情主观评价:45.9%表示明显好转,36.5%表示中度好转,16.5%表示稍有好转,1.1%表示无改变;两组患儿在治疗结束时进行疗效评估,SIT组控制率达85.5%,对照组为62.0%,两组比较差异有统计学意义(x2=10.150,P＜0.01),提示SIT有效..结论 哮喘特异性免疫治疗第20次注射后,螨过敏性哮喘患儿糖皮质激素吸入剂量显著减少;85%以上患儿在SIT结束时哮喘得到控制;总IgE和螨特异性IgE变化无统计学意义.     

Bone mineral density in prepubertal asthmatics receiving corticosteroid treatment

OBJECTIVE: To examine whether bone mass is reduced in prepubertal, asthmatics receiving high doses of inhaled corticosteroids. METHODOLOGY: A cross-sectional comparison of lumbar spine-bone mineral density (LS-BMD) was undertaken in 76 subjects after stratifying them according to dosage and administration route of corticosteroid. RESULTS: Weight was the only independent predictor of LS-BMD (r(2) = 0.38). Children receiving greater than 800 microg/day of inhaled corticosteroid plus intermittent oral corticosteroid had a significantly lower weight-adjusted LS-BMD than children treated with 400-800 microg/day of inhaled corticosteroid (mean difference: 0.06 g/cm(2), 95% confidence interval (CI): - 0.02 to - 0.10). A significant difference in weight-adjusted LS-BMD persisted when all children receiving greater than 800 microg/day of inhaled corticosteroid, irrespective of additional oral corticosteroid treatment, were compared with children receiving 400-800 microg/day of inhaled corticosteroid (mean difference: - 0.05 g/cm(2), 95%CI interval: -0.02 to - 0.09). Bone mass was similar in children not receiving any inhaled corticosteroid and those treated with 400-800 microg/day of inhaled corticosteroid. CONCLUSIONS: A reduced bone mass in prepubertal asthmatic children receiving high doses of inhaled corticosteroids may predetermine a compromised peak bone mass and increase osteoporotic fracture risk in adulthood.     

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目的观察布地耐德(BUD)联用福莫特罗(FOM)与单用双倍剂量BUD干粉吸入疗法对轻度持续性哮喘患儿的有效性和安全性,探讨儿童轻度持续性哮喘的理想治疗方案。方法选取2005-01—2005-06在广州医学院附属第一医院呼研所专科门诊就诊的轻度持续哮喘患儿50例,采取开放、随机、平行对照方法把50例患儿分为两组,分别吸入BUD联用FOM(B+F组)或双倍剂量BUD(Double B组)8周,药物均用都保干粉吸入装置吸入。8周的观察期内由患儿或家长记录哮喘日记,包括日间和夜间症状评分、无症状天数、其它平喘药物(包括应急用速效β2-受体激动剂、长效缓释茶碱、口服长效β2-受体激动剂、全身用糖皮质激素)使用情况,同时以简易峰流速仪监测其呼气峰流速值(PEF)作为主要肺功能指标。结果B+F组和Double B组在治疗8周后,日间症状及PEF均较治疗前明显改善,无症状天数明显增加,差异具有统计学意义(均P<0.05);与治疗前比较,B+F组在治疗8周后夜间症状评分明显下降(P<0.05),而Double B组治疗前后比较差异无统计学意义(P>0.05);两组间日间症状评分、夜间症状评分、无症状天数及PEF治疗前及治疗后比较差异均无统计学意义(均P>0.05)。两组间病情反复发作次数、需联合应用速效β2-受体激动剂次数及口服强的松、长效缓释茶碱或口服长效β2-受体激动剂的天数均无统计学意义(均P>0.05)。结论低剂量吸入糖皮质激素(ICS)联用长效β2-受体激动剂(LABA)与单用双倍剂量ICS治疗儿童轻度持续性哮喘的疗效相当。但从减少或避免ICS潜在的全身性副反应方面考虑,联用低剂量ICS+LABA可能是更好的选择。     

Inhaled corticosteroids for maintenance treatment in childhood pulmonary sarcoidosis

We present our experience with sequential oral and inhaled corticosteroid therapy in childhood pulmonary sarcoidosis. Fifteen children were followed-up for a mean of 7y. Treatment consisted of oral prednisolone 2mg/kg/d on initial diagnosis. After remission was reached, alternate day therapy with 1 mg/kg was continued. The dose was tapered to a maintenance dose which controlled the activity of the disease. When patients were free of symptoms and had no clinical and laboratory findings, inhaled corticosteriod treatment was started. Relapse treatment consisted of cessation of inhaled corticosteroids and start of oral corticosteroids at a dosage of 2 mg/kg/d and then a tapered dose. Five patients were given oral corticosteroids only. Nine patients were given inhaled steroids after oral corticosteroid therapy had been discontinued. Clinical and radiological remissions were achieved in every patient.
Conclusion : Sequential oral and inhaled corticosteroid therapy may be an alternative treatment regimen for sarcoidosis in children.     

Inhaled corticosteroid therapy is safe in tuberculin-positive asthmatic children

BACKGROUND: Although treatment with oral corticosteroids can cause reactivation of latent Mycobacterium tuberculosis (TB) infection in purified protein derivative (PPD)-positive individuals with no evidence of clinical disease, little is known about the effects of inhaled corticosteroids in this respect. OBJECTIVE: This study was undertaken to assess whether inhaled corticosteroid (CS) therapy reactivates latent TB infection in PPD-positive asthmatic children. METHOD: We studied 32 PPD skin test-positive (> or =10 mm) children [age (mean +/- SD), 7.9 +/- 4.1 years] with no family history and no evidence of TB infection on chest radiograms who were receiving inhaled budesonide for the treatment of asthma. They were further evaluated with thorax computed tomography (CT) and erythrocyte sedimentation rate and closely observed for an additional 9 months. RESULTS: At enrollment the mean diameter of PPD reaction was 12.8 +/- 2.7 mm. The mean duration of inhaled CS treatment and the mean cumulative CS dose were 9.8 +/- 7.6 months and 275 +/-199 mg, respectively. Thorax CT studies revealed mediastinal lymph nodes in 7 of the 32 patients. There was no significant difference between children with and without mediastinal lymph nodes according to age, gender, size of PPD skin testing, erythrocyte sedimentation rate and duration and cumulative CS dose of inhaled budesonide therapy before study. A second thorax CT was obtained 9 months later in those 7 patients with lymphadenopathy (additional mean cumulative CS dose, 222.57 mg). There was no change in the size of their lymph nodes. CONCLUSION: Long term inhaled budesonide therapy appears to be safe in PPD-positive asthmatic children.     

Effects of oral theophylline and oral salbutamol in the treatment of asthma.

A double-blind randomised controlled trial was conducted to study the effects of oral theophylline alone compared with oral theophylline and salbutamol in a sample of asthmatic children. Each treatment was administered at maximum recommended dosage. Children treated with the theophylline and salbutamol combination had higher pulse rates, lower peak flow measurements, and depressed blood theophylline levels. These results suggest that when given at maximum oral dosage, theophylline and salbutamol in combination, tend to interact negatively producing tachycardia and reduced therapeutic function.     

Behavior abnormalities and poor school performance due to oral theophylline use

Studies evaluating adverse effects of oral theophylline on learning and behavior have been performed on children with asthma receiving long-term theophylline therapy. To further differentiate the effects of asthma itself from the drugs used, we evaluated 20 asthmatic children (6 to 12 years of age) who had not received oral bronchodilators for at least 6 months. A double blind, placebo-controlled, parallel format was used with a 4-week theophylline or placebo period preceded by a 2-week baseline. Theophylline serum levels were maintained between 10 to 20 micrograms/mL. During baseline and treatment periods, the child's home and school behavior/performance were monitored independently by their parents and teachers using standardized report forms. A battery of psychologic tests was administered at the end of baseline and treatment periods. Seven children receiving theophylline were noted to have a change in school behavior and/or performance during their 4 weeks on drug compared to baseline, whereas none of the children receiving placebo were noted to be different (P = .004). Thus, the short-term administration of theophylline to asymptomatic asthmatic children not receiving oral bronchodilators can adversely affect school performance and behavior. Because this population represents the majority of asthmatic children, one needs to use theophylline cautiously in this age group, monitor school performance closely, or seek other treatment modalities.     

Serum concentrations of theophylline in children following the administration of doses generally recommended: new dosage regimen required.

Serum concentrations of theophylline following intravenous and oral administration of aminophylline were studied in asthmatic children, 2--17 years of age. The biological half-life (t 1/2 beta) of theophylline varied between 165 and 495 min. The results revealed that an intravenous loading dose of 6 mg of aminophylline per kg body weight was necessary in order to obtain therapeutic concentrations in children who had not received the drug for the last 6 to 8 hours. The maintenance dose should be determined and controlled by use of serum concentration determinations. In a group of children receiving 5 mg of aminophylline per kg body weight 3 times a day orally, none had concentrations within the therapeutic range in the morning, and only 39% reached therapeutic levels 2 h after the morning dose. No correlation was found between the serum concentration of theophylline and the amount of drug given per kg body weight. The results show that theophylline concentration analysis is necessary to obtain adequate therapeutic levels in children without risking toxic effects.     

Identifying problematic severe asthma in the individual child – does lung function matter?*

Aim: Measures of lung function (usually FEV₁ <80% predicted) are used to classify asthma severity in both adults and children, despite evidence that lung function impairment is less pronounced in the paediatric asthma population. The present study assesses the relevance of lung function measurements as discriminators of severe childhood asthma. Methods: Fifty‐one school‐aged children with problematic severe asthma, 37 mild‐to‐moderate asthmatics and 29 healthy controls underwent a comprehensive clinical work‐up. Problematic severe asthma was defined in patients exhibiting poor asthma control despite high‐dose inhaled corticosteroid treatment and at least one other asthma controller drug. Mild‐to‐moderate asthmatic children used low‐dose inhaled steroids and reported minimal asthma symptoms. Results: Baseline FEV₁ values were significantly reduced in children with problematic severe asthma, yet FEV₁ <80% predicted showed a low sensitivity (41%) for discriminating severe vs. mild‐to‐moderate asthma. Receiver‐operated characteristic analysis estimated the optimal cut‐off of FEV₁ to be 90% predicted in this population (sensitivity 61%, specificity 83%). Baseline FEV₁/FVC and FEF_25–75 values were not superior to FEV₁ in discriminating problematic severe asthma, and neither exhaled nitric oxide levels nor bronchial hyperresponsiveness differentiated between the two asthmatic study populations. Conclusion: Spirometric measurements are insensitive discriminators of problematic severe asthma in childhood.     

Inhaled corticosteroids or montelukast as the preferred primary long-term treatment for pediatric asthma?

According to current guidelines, inhaled corticosteroids (ICS) are the preferred primary long-term treatment for asthmatic children of all age groups, but leukotriene receptor antagonists can be considered to be an alternative treatment for mild persistent asthma. In this article, all randomized double-blind efficacy studies comparing the long-term (>4-week) treatment using a leukotriene receptor antagonist with an inhaled corticosteroid in asthmatic children were critically reviewed. In school-aged children, five reports with an adequate study design were available. All of these studies compared montelukast with inhaled fluticasone. The meta-analysis of the two main outcome measures, forced expiratory volume in 1 s (weighted mean difference, 4.6% predicted, 95% confidence interval: 3.5–5.5) and asthma control days (respectively, 5.6%, 4.3–6.9) demonstrated the superiority of fluticasone over montelukast. Many other clinical and pulmonary outcomes also consistently showed that low-dose inhaled fluticasone was more effective than montelukast in the long-term management of mild to moderate persistent asthma. A more favorable response to fluticasone over montelukast was associated with more severe disease or markers of allergic inflammation. About a quarter of patients benefited more from montelukast than fluticasone. In children under school age, no comparative studies were available. However, long-term montelukast treatment was found to be effective in placebo-controlled studies in asthmatic children aged >2 years. These findings support the present international recommendations for ICS as the preferred first-line controller therapy for mild to moderate persistent childhood asthma. If montelukast is selected as a monotherapy and asthma is not adequately controlled within 4–6 weeks, the treatment should be discontinued and the preferred medication initiated. Supported by the Academy of Finland. The author has no conflict of interest in connection with this paper. An erratum to this article can be found at