常规肺通气功能检测在儿童支气管哮喘诊疗中的作用

目的 通过对比支气管哮喘(哮喘)患儿规范化治疗前后肺功能指标的变化,探讨其大小呼吸道功能改变及改变时间段.通过对比哮喘患儿吸入支气管扩张剂前后肺功能变化,明确哮喘患儿对支气管扩张剂的反应及呼吸道狭窄、呼吸道阻塞的可逆性.方法 采用肺功能测定系统对25例哮喘患儿分别于哮喘急性发作期、正规治疗后缓解期3个月、6个月、1 a行常规肺通气功能测定,比较各期实测值与预测值;并从中选出10例患儿于急性发作期行支气管舒张试验,比较支气管扩张剂雾化吸入前后其肺功能指标变化. 结果 哮喘患儿急性发作期用力肺活量(FVC)、一秒钟用力呼气量(FEV1)、1秒率(FEV 1.0%)、最大呼气流量(PEF)、25%用力呼气肺活量(FEF25)、FEF50、FEF75、中段呼气流速(MMEF75/25)等实测值均较预测值降低,治疗3个月FVC、FEV1等大呼吸道功能指标恢复,治疗1 a、FEF50、FEF75、MMEF75/25等小呼吸道功能指标恢复.哮喘患儿支气管扩张剂雾化吸入后大呼吸道功能指标FEV1、PEF及小呼吸道功能指标FEF50、FEF75、MMEF75/25等均较雾化前恢复.结论 哮喘患儿的肺功能指标在急性期和缓解期存在特异性动态变化,肺功能检测在儿童哮喘的诊断、疗效及病情判断方面具有良好的作用.     

布地奈德福莫特罗粉吸入剂与布地奈德粉吸入剂联合富马酸福莫特罗粉吸入剂治疗哮喘的疗效及安全性

目的 观察布地奈德福莫特罗粉吸入剂与布地奈德粉吸入剂联合富马酸福莫特罗粉吸入剂治疗儿童哮喘的疗效及安全性.方法 采用随机、开放、平行对照研究方法 ,将80例中度哮喘患儿随机分为治疗组和对照组.治疗组应用布地奈德福莫特罗粉吸入剂治疗12个月,对照组应用布地奈德粉吸入剂加富马酸福莫特罗粉吸入剂治疗12个月.分别于治疗前及治疗1个月、3个月、6个月、9个月、12个月进行随访,观察期内由患儿家长记录哮喘日记,包括日间和夜间咳嗽症状评分.根据患儿家长记录计算日间和夜间咳嗽症状评分.同时测量患儿最大呼气流量(PEF),每月进行一次儿童哮喘控制测试(C-ACT),并观察不良反应发生情况.应用SPSS 12.0软件进行统计学分析.结果 治疗组临床控制率明显优于对照组,二组总有效率比较差异有统计学意义(P<0.05).治疗1个月、3个月、6个月、9个月、12个月,治疗组和对照组与治疗前比较,日、夜间咳嗽情况评分、PEF值及C-ACT评分均明显改善,差异均有统计学意义(Pa<0.05).治疗组治疗后日、夜间症状评分、PEF值均显著低于对照组,差异均有统计学意义(Pa<0.05),但C-ACT评分比较差异无统计学意义(Pa>0.05).结论 布地奈德福莫特罗粉吸入剂与布地奈德粉吸入剂联合富马酸福莫特罗粉吸入剂治疗均具有良好的疗效及安全性,但应用布地奈德福莫特罗粉吸入剂效果更好.     

以胸闷为主诉的不典型支气管哮喘患儿激发试验前后的肺功能特点

目的 了解以胸闷为主诉的不典型支气管哮喘患儿在支气管激发试验前后的肺功能特点。方法 选取2010 年1 月至2013 年12 月在我院肺功能室进行支气管激发试验的不典型哮喘患儿34 例为研究对象(不典型哮喘组),同期选取典型哮喘患儿34 例为对照,检测不典型哮喘组患儿支气管激发试验前后的肺功能,以及典型哮喘组患儿发作期和缓解期肺功能。结果 不典型哮喘组激发前肺功能指标用力肺活量(FVC)、第1 秒最大呼气量(FEV1)、FEV1/FVC、呼气峰流速(PEF)、用力呼气25 %、50 %、75%肺活量时的呼气峰流速(FEF25、FEF50、FEF75)、最大呼气中期流量(MMEF75/25)分别为105%±12%、104%±12%、100%±7%、88% ±13%、90% ±14%、81% ±17%、73% ±25%、80%±17%,明显高于典型哮喘组患儿发作期肺功能各指标(PP>0.05)。不典型哮喘组激发后肺功能各指标与典型哮喘组发作期相比差异无统计学意义(P>0.05),但均低于典型哮喘组缓解期和不典型哮喘组激发前水平。结论 支气管激发试验有助于不典型哮喘患儿的诊断。     

常规肺通气功能检测在儿童哮喘评估中的应用

目的探讨哮喘病情与肺功能指标变化特点,为哮喘规范化治疗提供客观依据。方法采用肺功能测定系统对25例哮喘患儿于急性期、缓解期6个月及1年分别行常规肺通气功能测定,比较各期实测值与预计值比值之间的差异。结果哮喘患儿的症状与肺功能指标呈现出一致性,急性期大气道指标用力肺活量(FVC)、1秒钟用力呼气量(FEV1)、最大呼气峰流量(PEF)及75%、50%、25%肺活量时用力呼气流速(FEF25、50、75)、中段呼气流速(MMEF75/25)等实测值与预计值比值均降低,治疗6个月后FVC、FEV1等大气道功能指标基本恢复,1年后小气道功能指标FEF50、75及MMEF75/25等指标恢复。结论肺功能指标在哮喘的病情评估方面具有重要作用,对于哮喘治疗具有重要指导作用。     

哮喘和咳嗽变异性哮喘儿童肺常规通气功能的比较

目的：比较哮喘与咳嗽变异性哮喘（CVA）患儿肺常规通气功能的变化。方法：选择2010年 5月至2011年5月确诊为哮喘或CVA的患儿140例,分为哮喘急性发作组（发作组,50例）、哮喘缓解组（缓解组,50例）和CVA组（40例）;同期正常健康体检儿童30例作为对照组。测定4组儿童用力肺活量(FVC)、一秒钟用力呼气容积(FEV1)、最大呼气峰流速(PEF)、用力呼气25%流速(FEF25)、用力呼气50%流速(FEF50)、用力呼气75%流速(FEF75)、最大呼气中期流速(MMEF75/25)等7项肺功能指标。结果：发作组患儿各项肺功能指标如大气道指标FVC、FEV1、PEF、FEF25及小气道指标FEF50、FEF75、MMEF75/25的实际值/预计值平均水平均<80%,且以FEF50、FEF75、MMEF75/25等小气道指标下降为著。CVA组患儿小气道指标FEF75、MMEF75/25实际值/预计值的平均水平<80%。发作组各项肺常规通气功能指标均低于对照组;缓解组、CVA组FVC、FEV1、FEF25及 MMEF75/25实际值/预计值的平均水平低于对照组;发作组各项肺功能指标均明显低于缓解组和CVA组;CVA组与缓解组各项肺功能指标差异均无统计学意义。结论：哮喘急性发作期患儿存在大小气道功能障碍,以小气道功能障碍为主;CVA患儿以小气道功能轻微障碍为主,与哮喘缓解期相似。     

节段性或大叶性肺炎支原体肺炎患儿的肺功能变化

目的探讨节段或大叶性肺炎支原体肺炎患儿肺功能的变化。方法检测159例节段或大叶性肺炎支原体肺炎患儿在急性期、恢复期的肺功能,并分析比较其变化。结果节段或大叶性肺炎支原体肺炎患儿急性期的1秒钟用力呼气容积(FEV1)、用力肺活量(FVC)、呼气峰流速(PEF)、25%用力肺活量时的用力呼气流量(FEF25)、50%用力肺活量时的用力呼气流量(FEF50)、75%用力肺活量时的用力呼气流量(FEF75)和最大呼气中期流速(FEF25-75)与预测值比较均明显降低,差异有统计学意义(P<0.01);恢复期各项指标均明显上升,但代表小气道功能的指标FEF50、FEF75、FEF25-75与预测值差异仍有统计学意义(P<0.01)。结论节段或大叶性肺炎支原体肺炎患儿,急性期时大、小气道均受损,恢复期时小气道损伤仍持续存在,定期随访肺功能有利于了解病情恢复情况及预后。     

哮喘儿童支气管舒张试验中大小气道功能指标变化对比研究

目的 探讨儿童哮喘发作时支气管舒张试验中大小气道功能指标变化的临床意义.方法 选择2012年10月至2014年4月哮喘初次发作患儿51例,采用Master Screen肺功能仪,在雾化吸入硫酸沙丁胺醇前、后进行肺功能检测;比较用力肺活量(FVC)、呼气峰流速(PEF)、1秒用力肺活量(FEV1)、1秒率(FEV1/FVC)、最大呼气中段流量(MMEF)、用力呼气流速(FEF)25、FEF50、FEF75的变化.结果 51例患儿的平均年龄(7.30±2.33)岁.患儿哮喘发作时支气管舒张试验总阳性率58.8%,并有随病情加重而升高的趋势;与舒张试验前比较,舒张试验后大小气道各指标的绝对值、占预计值百分比均明显增加,差异有统计学意义(P均<0.01);以代表大气道指标的FEV1改善率≥12%判定为舒张试验阳性,阳性率58.8%;以代表小气道指标的MMEF改善率≥25%判定为舒张试验阳性,阳性率70.6%,两者比较差异无统计学意义(P=0.214).结论 哮喘发作患儿FEV1基础值>70%亦可行支气管舒张实验,同时结合大、小气道指标以判断气道可逆性可以更全面反映哮喘的病情严重程度.     

布地奈德/福莫特罗干粉吸入剂治疗支气管哮喘的疗效

目的 探讨布地奈德/福莫特罗干粉吸人剂治疗儿童支气管哮喘的疗效、依从性和安全性.方法 采用随机、开放、平行对照研究方法,44例支气管哮喘患儿分为A组(布地奈德/福莫特罗干粉吸入剂,30例)和B组(布地奈德干粉吸入剂加福莫特罗干粉吸入剂,14例).A组使用单个吸入器吸入布地奈德/福莫特罗干粉吸入剂[80μg(布地奈德)/4.5μg(福莫特罗)/吸],1吸/次,2次/d,共12周;B组每天分别使用2个吸入器吸入布地奈德干粉吸入剂(100μg/吸)和福莫特罗干粉吸入剂(4.5μg/吸),1吸/次,2次/d,共12周.观察二组患儿每天症状评分、视觉近似评价量尺(VAS量尺)、最大呼气峰流速[最大呼气流量(PEF)占预计值%]、肺功能[一秒钟用力呼气量(FEV1)占预计值%]和不良事件发生情况.采用SPSS 11.0软件进行统计学分析.结果 用药后,二组哮喘患儿的临床症状均改善.治疗8、12周A组改善明显,与B组比较差异显著(Z=-2.223,-2.042 Pa<0.05);治疗8、12周VAS量尺评分A组降低较B组明显(Z=-3.877,-3.536 Pa<0.05);PEF占预计值%和FEV1占预计值%二组均有改善,A组在治疗4周PEF占预计值%改善快于B组(Z=-2.602 P<0.05).A组在治疗12周FEV1占预计值%改善优于B组(Z=-1.966 P<0.05),二组均无明显不良事件发生.结论 布地奈德/福莫特罗干粉吸入剂和布地奈德干粉吸入剂加福莫特罗干粉吸人剂联合治疗哮喘患儿都具有良好的疗效和安全性,但布地奈德/福莫特罗干粉吸入剂起效更快,使用更方便,患儿依从性更好.     

福莫特罗治疗哮喘急性发作期患儿即刻肺功能变化

目的探讨哮喘急性发作期患儿吸入福莫特罗后起效时间和及即刻肺功能变化。方法能掌握肺功能测定方法及都保吸入方法的急性发作支气管哮喘患儿52例,测基础肺功能,随机分为A组吸入福莫特罗4.5μg,B组吸入9.0μg,吸药3～5min后复查肺功能。结果两组吸药后第1秒用力呼气肺活量占预计值的百分比(FEV1%)、呼气峰流速占预计值的百分比(PEF%)及最大呼气中段流速占预计值的百分比(MMEF%)均有明显改善(P均<0.05)。B组吸药后肺功能改善较A组更显著。结论福莫特罗起效迅速,可快速缓解哮喘症状。     

慢性咳嗽儿童140例肺功能的特点

目的分析慢性咳嗽儿童肺功能,探讨慢性咳嗽病因与咳嗽变异性哮喘(CVA)的相关性。方法慢性咳嗽患儿140例,根据第1s用力呼气容积(FEV1)或最大呼气流量(PEF)分成二组:运动试验组93例,舒张试验组47例。二组分别予运动和舒张试验。检测二组患儿肺功能,包括用力肺活量(FVC)、FEV1、PEF、用力呼吸50%及75%肺活量时瞬间流量(FEF50及FEF75)。结果运动试验组阳性30例,其FEV1及PEF变异率分别为(18.30±10.50)%及(18.78±9.44)%;舒张试验组阳性35例,FEV1及PEF变异率分别为(30.36±27.27)%及(36.13±26.83)%。结论FEV1、PEF可用于评价CVA儿童的呼吸道阻塞程度。肺功能可客观评价慢性咳嗽呼吸道反应性及炎性反应程度。     

Budesonide/formoterol improves lung function compared with budesonide alone in children with asthma.

We aimed to compare the efficacy and safety of budesonide/formoterol (Symbicort) with budesonide alone (Pulmicort) or budesonide (Pulmicort) and formoterol (Oxis) administered via separate inhalers in children with asthma. In a 12 wk, double-blind study, a total of 630 children with asthma (mean age 8 yr [4-11 yr]; mean forced expiratory volume in 1 s (FEV(1)) 92% predicted; mean inhaled corticosteroid dose 454 microg/day) were randomized to: budesonide/formoterol (80/4.5 microg, two inhalations twice daily); a corresponding dose of budesonide alone (100 microg, two inhalations twice daily); or a corresponding dose of budesonide (100 microg, two inhalations twice daily) and formoterol (4.5 microg, two inhalations twice daily) (budesonide + formoterol in separate inhalers). The primary efficacy variable was the change from baseline to treatment (average of the 12-wk treatment period) in morning peak expiratory flow (PEF). Other changes in lung function and asthma symptoms were assessed, as was safety. Budesonide/formoterol significantly improved morning PEF, evening PEF and FEV(1) compared with budesonide (all p < 0.001); there was no significant difference between budesonide/formoterol and budesonide + formoterol in separate inhalers for these variables. All other diary card variables improved from baseline in all treatment groups; there were no significant between-group differences. Adverse-event profiles were similar in all groups; there were no serious asthma-related adverse events in any treatment group. Conclusion: budesonide/formoterol significantly improved lung function in children (aged 4-11 yr) with asthma compared with budesonide alone. Budesonide/formoterol is a safe and effective treatment option for children with asthma.     

A randomised controlled trial of short term growth and collagen turnover in asthmatics treated with inhaled formoterol and budesonide.

AIMS: To determine effects on short term growth and collagen turnover of adding formoterol (Eformoterol) to half the glucocorticoid dose in children with asthma, treated with inhaled budesonide (Pulmicort Turbuhaler). DESIGN: A randomised double blind, placebo controlled crossover study with two six-week periods. SETTING: Outpatient clinic in secondary referral centre. SUBJECTS: A total of 27 prepubertal children aged 6-13 years. INTERVENTIONS: Formoterol 12 microg and dry powder budesonide 100 microg twice daily in one period; placebo and dry powder budesonide 200 microg twice daily in the other. OUTCOME MEASURES: Primary outcome measures were lower leg growth rate, and serum and urine markers of type I and type III collagen turnover. Secondary outcome measures were inflammation markers in serum, and parameters of asthma control. RESULTS: During budesonide 200 microg twice daily treatment, mean lower leg growth rate was 0.14 mm/week (p = 0.02) lower than during the formoterol and budesonide period. Similar statistically significant effects on markers of collagen turnover were found, whereas inflammation markers and asthma control did not vary statistically significantly between the two periods. CONCLUSIONS: In children treated with inhaled glucocorticoids, halving the dose and adding formoterol is associated with faster short term growth and an increase in markers of collagen turnover, with no loss of asthma control.     

吸入糖皮质激素对支气管哮喘患儿血清基质金属蛋白酶9及基质金属蛋白酶抑制物1的影响

目的 观察吸入糖皮质激素对支气管哮喘(哮喘)患儿血清基质金属蛋白酶9( MMP-9)及基质金属蛋白酶抑制物1( TIMP-1)的影响,探讨糖皮质激素降低呼吸道重塑的机制.方法 哮喘患儿50例.给予糖皮质激素信必可都保(布地奈德/福莫特罗粉吸入剂),每吸含布地奈德80 μg、福莫特罗4.5 μg,每日2次,疗程12周,采用ELISA法测定布地奈德/福莫特罗粉吸入剂吸入前后,血清MMP-9、TIMP-1水平及肺功能指标[第1秒最大呼气量(FEV1)、最大呼气流速峰值(PEF)]的变化,并对二者进行相关性分析.结果 使用吸入糖皮质激素布地奈德/福莫特罗粉剂后,哮喘患儿血清MMP-9水平由吸入前的(43.25±13.26) μg?L-1下降至(29.62±12.47) μ.g? L-1,TIMP-1由吸入前的(119.88±32.56)μg?L-1上升至(143.15±45.36) μg?L-1,差异均有统计学意义(Pa＜0.01).PEF及FEV1变异占预计值百分比分别由吸入前的(76.15±3.26)％,(73.12±4.63)％,上升至(85.42±4.73)％,(86.49±3.72)％,PEF及FEV1变异占预计值百分比与MMP-9/TIMP-1比率均呈负相关(r=-0.402、-0.364,Pa＜0.05).结论 糖皮质激素可通过调节MMP-9/TIMP-1的平衡,降低胶原沉积,从而干预呼吸道重塑的发生.     

A randomised controlled trial of short term growth and collagen turnover in asthmatics treated with inhaled formoterol and budesonide

AIMS—To determine effects on short term growth and collagen turnover of adding formoterol (Eformoterol) to half the glucocorticoid dose in children with asthma, treated with inhaled budesonide (Pulmicort Turbuhaler).
DESIGN—A randomised double blind, placebo controlled crossover study with two six-week periods.
SETTING—Outpatient clinic in secondary referral centre.
SUBJECTS—A total of 27 prepubertal children aged 6-13 years.
INTERVENTIONS—Formoterol 12 µg and dry powder budesonide 100 µg twice daily in one period; placebo and dry powder budesonide 200 µg twice daily in the other.
OUTCOME MEASURES—Primary outcome measures were lower leg growth rate, and serum and urine markers of type I and type III collagen turnover. Secondary outcome measures were inflammation markers in serum, and parameters of asthma control.
RESULTS—During budesonide 200 µg twice daily treatment, mean lower leg growth rate was 0.14 mm/week (p = 0.02) lower than during the formoterol and budesonide period. Similar statistically significant effects on markers of collagen turnover were found, whereas inflammation markers and asthma control did not vary statistically significantly between the two periods.
CONCLUSIONS—In children treated with inhaled glucocorticoids, halving the dose and adding formoterol is associated with faster short term growth and an increase in markers of collagen turnover, with no loss of asthma control.

     

布地奈德/福莫特罗干粉吸入剂和喘可治联合治疗儿童支气管哮喘的临床研究

目的 评估布地奈德/福莫特罗干粉吸入剂和喘可治注射液联合治疗儿童支气管哮喘(轻度持续-中度持续)的临床疗效、依从性和安全性.方法 采用随机、开放、平行对照研究方法,将64例患儿分为A组(布地奈德/福莫特罗干粉吸入剂组)37例和B组(布地奈德/福莫特罗干粉吸入剂+喘可治联合治疗组)27例,观察临床症状评分、视觉近似评价量尺(VAS量尺)、儿童哮喘控制测试(ACTCH)、最大呼气峰流速(PEF占预计值%)、肺功能(FEV1占预计值%)和不良事件发生情况.结果 A、B两组药物治疗都可改善患儿的临床症状,但B组改善更明显(P<0.05);PEF占预计值%和FEV1占预计值%方面,两组都有改善,B组在治疗后4周改善PEF占预计值%快于A组(P<0.05),在治疗后4周、8周、12周改善FEV1占预计值%也优于A组(P<0.05),两组无明显不良事件发生.结论 布地奈德/福莫特罗干粉吸入治疗和布地奈德/福莫特罗干粉吸入剂+喘可治联合治疗儿童支气管哮喘(轻度持续-中度持续)都具有良好的疗效和安全性,依从性好,但布地奈德/福莫特罗干粉吸入剂+喘可治联合治疗改善病情更快,疗效更好.     

Effectiveness of inhaled corticosteroids in controlling acute asthma exacerbations in children at home

Many clinicians advise their patients to increase the dose of inhaled corticosteroids during acute asthma exacerbations, without strong clinical evidence supporting this treatment. This study investigates the effectiveness of inhaled corticosteroids in controlling acute asthma exacerbations in children at home. The study population consisted of children with mild intermittent, mild and moderate persistent asthma aged 1 to 14 years who were treated in our outpatient clinic with inhaled budesonide for 1 year. After participating in an asthma education session, the parents were instructed to initiate treatment with inhaled budesonide at the first signs of asthma exacerbation, starting with 200 to 400 microg budesonide, in combination with beta-2 agonists 4 times a day and followed by a decrease in the dose in 4 to 8 days. Asthma status and peak expiratory flow rates were measured in the 3 monthly follow-up visits. Only children who complied with the treatment regimen and came for follow-up visits regularly were included in the final analysis. One hundred fifty children used our treatment protocol with inhaled budesonide to control their asthma attacks. Clinical improvement of asthma symptoms was achieved after a mean of 1.8 +/- 0.7 days from the beginning of treatment. The parents were able to control 94% of the 1,061 episodes of asthma exacerbation occurring during a cumulative follow-up period of 239 years. In the 3-month period before enrollment, 101 children (67%) had used oral corticosteroids to control their asthma attacks and 50 (33%) were hospitalized. During the entire follow-up period, only 11 children (7%) used oral corticosteroids, and none of the children were hospitalized. The present study demonstrates that children with asthma can control their exacerbations at home using inhaled corticosteroids (budesonide). Treatment, starting with relatively high doses followed by a rapid reduction in dose over 4-8 days, resulted in a decrease in the use of oral steroids and in hospitalization. To achieve good results, patient compliance is essential.     

Effect of formoterol on clinical parameters and lung functions in patients with bronchial asthma: a randomised controlled trial.

AIMS: To determine the role of formoterol in the treatment of children with bronchial asthma who are symptomatic despite regular use of inhaled corticosteroids. METHODS: A randomised, double blind, parallel group, placebo controlled study to investigate the effects of inhaled formoterol (12 microg twice a day) in 32 children with moderate to severe bronchial asthma. The study consisted of two week run in periods and six week treatment periods, during both of which the patients continued their regular anti-inflammatory drugs. The efficacy parameters were symptom scores, bronchodilator use, daily peak expiratory flow rates (PEFR), methacholine hyper-reactivity, forced expiratory volume in one second (FEV1), lung volumes, and airway conductance. RESULTS: Formoterol treatment for six weeks decreased symptom scores, PEFR variability, and the number of rescue salbutamol doses, and increased morning and evening PEFR significantly. No adverse reactions were seen. CONCLUSION: These findings suggest that inhaled formoterol is effective in controlling chronic asthma symptoms in children who are symptomatic despite regular use of inhaled corticosteroids.     

Inhaled budesonide reduces lung hyperinflation in children with asthma

Previous studies have shown that asthmatics have hyperinflation as defined by larger total lung capacity. The present study was set up in order to document changes in asthma clinic, airway calibre, airway reactivity and lung volumes after budesonide treatment. After a 2-week run-in period, 28 children with moderate persistent asthma were treated in a double-blind manner either with budesonide (0. 4 mg/day) or placebo for 8 weeks and, thereafter, all patients were treated with open-label budesonide for a further 20 weeks. Symptoms, bronchodilator requirements and airway calibre improved significantly after 8 weeks of treatment ( p < 0. 05 for each) and prolonged treatment did not cause any further improvement. Reduction in hyperreactivity was apparent only after 20–28 weeks of treatment. Total lung capacity decreased along with budesonide treatment in both groups suggesting that early introduction of an inhaled corticosteroid may be useful in the prevention of asthma-related remodelling of the lung and thoracic cage.     

Importance of the inhalation device on the effect of budesonide.

Two hundred and forty one children with chronic perennial asthma, who had been treated with budesonide via a metered dose inhaler with a spacer device (Nebuhaler), had their normal dose of budesonide reduced by 50% to determine if they had been overtreated. Within three weeks, asthma control deteriorated in 126 patients to such an extent that budesonide had to be increased to the normal dose. After stabilising their asthma, these children were enrolled in a randomised, double blind, double dummy, parallel study, performed to compare the effect of budesonide via Nebuhaler with that of half the dose of budesonide via Turbuhaler. The study started with a two week run-in during which patients were treated with their normal dose of budesonide via Nebuhaler. After run-in, 64 children were randomised to treatment with their normal budesonide treatment and the remaining 62 children to treatment with half their normal dose via Turbuhaler for nine weeks. Throughout the study, patients recorded asthma symptoms, peak flow measurements, and beta 2 agonist use in a diary. Pulmonary function tests, exercise tests, and 24 hour urine sample collections were performed at hospital visits during run-in and the study period. Apart from beta 2 agonist use, which was significantly lower for patients on Turbuhaler treatment than on Nebuhaler treatment, there were no differences between the groups in any of the parameters studied during run-in or during the study period. Furthermore, there was no trend of deterioration in asthma control when the dose of budesonide was reduced by 50% when Turbuhaler was the inhalation device. It is concluded that budesonide via Turbuhaler is more effective than via Nebuhaler in the treatment of asthma. Based on this finding, attempts should be made to reduce the dose of budesonide when patients are switched from Nebuhaler to Turbuhaler treatment.