儿童哮喘控制水平的影响因素和评估指标分析

目的 分析儿童哮喘控制水平的影响因素,评价哮喘评估指标的实用性。方法 选取185例哮喘患儿,采用问卷及肺功能检测的方法,分析儿童哮喘控制水平及影响因素,以及评估指标与哮喘控制水平的相关性。结果 185例患儿中,完全控制的139例 （75.1%）,部分控制的36例 （19.5%）,未控制10例 （5.4%）。是否规范吸入糖皮质激素和嗜酸性粒细胞计数水平对哮喘控制的影响有统计学意义 （P < 0.05）。第1秒用力呼气容积占预计值的百分比 （FEV1%）、呼出气一氧化氮 （FeNO）以及儿童哮喘控制测试问卷 （C-ACT）、儿科哮喘生命质量调查问卷 （PAQLQ）得分等哮喘检测指标在控制组、部分控制组和未控制组之间的差异有统计学意义 （P < 0.05）。哮喘患儿FEV1%与C-ACT、PAQLQ呈正相关性 （r = 0.214、0.312,P < 0.05）,而与FeNO水平没有显著的相关性 （r = -0.18,P > 0.05）。结论 吸入糖皮质激素治疗的依从性和嗜酸性粒细胞计数水平是儿童哮喘控制的影响因素。联合FEV1%、FeNO水平以及C-ACT、PAQLQ评分等多个指标评估哮喘控制水平,更有利于儿童哮喘的临床诊疗。     

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目的探究儿童哮喘控制测试(C-ACT)评分与哮喘患儿肺功能及气道反应性的相关关系。方法对2009年10月至2010年5月在重庆医科大学附属儿童医院哮喘门诊就诊的273例哮喘患儿,测量肺功能并同时完成C-ACT评分,以第1秒用力呼气流量占预计值百分比(FEV1%)和最大呼气流量占预计值百分比(PEF%)作为通气功能指标与C-ACT进行相关性分析;根据乙酰甲胆碱激发实验将气道反应性分为重度、中度、轻度和极轻度4级,比较各级间C-ACT得分及大小气道通气功能指标的差异,研究C-ACT与通气功能及气道反应性的关系。结果 C-ACT与FEV1%、PEF%的相关系数分别为0.25和0.34(P<0.01),去除就诊前4周患上呼吸道感染和小于7岁的患儿后,其相关系数分别为0.42和0.52(P<0.01);气道反应性重度和极轻度组间C-ACT得分差异有统计学意义(P<0.01),中度和轻度组间差异无统计学意义(P>0.05)。结论 C-ACT评分与哮喘患儿通气功能、气道反应性有较好的相关性,就诊前4周内是否患有上呼吸道感染和年龄是影响其相关性的两个主要因素。     

哮喘控制问卷在支气管哮喘患儿中的应用

目的对哮喘控制问卷(ACQ)和改良哮喘控制问卷(不计肺功能,简称ACQ6)在儿童哮喘控制评估中应用的可行性进行探讨。方法选取青岛大学医学院附属医院哮喘专家门诊确诊的哮喘患儿102例,进行肺功能测试,包括一秒钟用力呼气量占预计值百分比(FEV1%)和最大呼吸流量占预计值百分比(PEF%),并进行ACQ调查;同时根据2006《哮喘管理和预防的全球策略》的哮喘控制分级标准,对哮喘患儿进行病情界定并分为控制组、部分控制组及未控制组。对3组患儿ACQ和ACQ6得分进行比较;并以FEV1%和PEF%为分组依据,比较ACQ6得分在不同FEV1%、PEF%组间的差异,分析ACQ6得分与FEV1%和PEF%的趋同性和一致性;分别对ACQ得分、ACQ6得分、FEV1%、PEF%与专家哮喘控制评估结果进行相关性分析,以检验其相关密切程度。结果 3组哮喘患儿的ACQ和ACQ6得分比较差异有统计学意义(F=171.52、117.14,Pa<0.01);ACQ6得分在不同FEV1%、PEF%水平间差异均有统计学意义(F=69.53、76.20,Pa<0.01);ACQ6与FEV1%的Spearman相关系数为-0.818,与PEF%的Spearman相关系数为-0.862,ACQ6与PEF%的相关性较FEV1%的相关性高;ACQ得分、ACQ6得分、FEV1%及PEF%与专家评估结果的Spearman相关系数分别为0.931、0.915、-0.878和-0.882,与专家评估结果关系的密切相关程度从高到低依次为ACQ>ACQ6>PEF%>FEV1%。结论 ACQ和ACQ6对不同哮喘控制水平的患儿具有良好的鉴别能力。ACQ完全可应用于儿童哮喘控制水平的评估;在缺乏肺功能设备的基层医院,ACQ6值得推广应用。     

哮喘儿童呼出气一氧化氮与肺功能及哮喘控制测试相关性研究

目的 探讨哮喘儿童呼出气一氧化氮（FeNO）水平与肺功能、哮喘控制测试（ACT）三者间的相关性及其在哮喘病情评估中的临床意义。方法 以2011年5月至2012年1月于中国医科大学附属盛京医院小儿哮喘门诊就诊的136例5～15岁哮喘儿童为研究对象,分别测定其FeNO水平、肺功能和ACT评分,分析三者间是否存在相关性。结果 FeNO水平与ACT评分水平呈负相关（r=-0.251,P＜0.005）。FeNO水平与肺功能FEV1/FVC（第1秒用力呼气容积/用力肺活量）呈负相关（r=-0.206,P＜0.05）,与FEV1及PEF不相关。ACT评分与肺功能FEV1/FVC呈正相关（r=0.242,P＜0.01）,与FEV1及PEF不相关。结论 针对所有研究对象,哮喘儿童FeNO水平与ACT评分呈负相关,与FEV1/FVC呈负相关, ACT与肺功能FEV1/FVC呈正相关,然而分组研究后,三者不具备稳定的相关性。FeNO评估哮喘儿童气道炎症,ACT评估哮喘患儿疾病控制水平,肺功能评价哮喘患儿气道阻塞情况,三者是从儿童哮喘的不同方面进行评估,互为补充,均具有重要临床意义,共同应用可提高儿童哮喘控制及诊治水平。     

喘可治注射液治疗儿童支气管哮喘随机、双盲、安慰剂对照的临床和实验研究

目的研究喘可治注射液对儿童哮喘的临床疗效和对Th1/Th2平衡的调节。方法随机、双盲,安慰剂、平行对照研究68名5～14岁哮喘或哮喘合并过敏性鼻炎儿童,随机分为治疗组和对照组,分别接受喘可治或银杏注射液治疗。观察两组每日症状评分,早、晚最大呼气峰流速测定(PEF),肺功能检查(FEV1)。实验室检测细胞内细胞因子IFN-γ/IL-4的表达率。结果治疗后症状评分治疗组中位数为6.0(P25～P75为4.9～21.5),对照组为10.0(P25～P75为6.19～27.5),两组比较差异有显著性;PEF变异率治疗组为4.3%±5.1%,对照组为5.9%±6.7%,两组变异率趋势曲线差异有显著性;治疗组FEV1增加值(△FEV1)较对照组显著改善;治疗后治疗组CD4 淋巴细胞内表达IFN-γ与对照组比较有显著升高。结论喘可治治疗有助于改善哮喘患儿临床症状,降低PEF变异率,改善肺功能,并且对Th1/Th2细胞的平衡具有积极的调节作用,促进Th1细胞的优势表达,有利于哮喘症状的改善和长期稳定。     

过敏性哮喘患儿使用奥马珠单抗的有效性和安全性评估：中国真实世界中的回顾性多中心研究

目的在中国真实世界中评估过敏性哮喘患儿使用奥马珠单抗的有效性与安全性。方法回顾性分析2018年7月6日至2020年9月30日在中国17家医院接受奥马珠单抗治疗的6～11岁过敏性哮喘患儿的临床资料。采集数据包括患儿接受治疗前的人口学特征、过敏史、家族史、总免疫球蛋白E(IgE)与特异性IgE、皮肤点刺试验、呼出气一氧化氮(FeNO)水平、嗜酸性粒细胞(EOS)计数、合并症;描述性分析奥马珠单抗治疗模式, 包括首次剂量、注射间隔频率和疗程与说明书推荐模式的差异;分析奥马珠单抗治疗后疗效整体评估(GETE), 比较治疗前后中重度哮喘急性发作率的差异、吸入糖皮质激素(ICS)剂量的变化、肺功能变化, 基线与奥马珠单抗治疗后第4、8、12、16、24、52周时儿童哮喘控制测试(C-ACT)和儿童哮喘生活质量问卷(PAQLQ)的变化、合并症改善;安全性评估数据包括不良事件(AE)与严重不良事件(SAE)。对"中重度哮喘年化发作率"以及"ICS减量"指标采用t检验进行差异分析, 显著水平为0.05。其他指标均为描述性分析。共纳入200例患儿, 其中男151例(75.5%), 女49例(24.5%);...     

122例门诊儿童哮喘临床分析

目的：了解深圳地区儿童哮喘发病情况和过敏原及肺功能变化。方法：应用皮肤点刺试验测定儿童哮喘患者的过敏原。应用F2600和303型肺功能仪分别测定不同年龄组哮喘儿童发作期的肺功能变化。结果：122例患者中过敏原测定96例呈阳性反应，阳性率78.7%，对屋尘过敏者81例，占84.4%，对尘螨过敏者63例，占65.6%，对多价昆虫过敏者49例，占51.0%。0～3岁组哮喘发作时75%潮气量与最高呼气流速之比(25/PF)值为(0.4637±0.0969)，潮气量与最高呼气流速之比(%V-PF)值为(0.1579±0.1000)，吸气时间与总呼吸时间之比(Ti/Tt)值为(0.3760±0.0377)，中期呼气流速与中期吸气流速之比(Me/Mi)值为(0.6437±0.1308)，与正常值比较均有显著差异，P<0.01。4～6岁组和7岁以上组哮喘发作期用力肺活量(FVC)、1秒钟用力呼气量(FEV1)、FEV1/FVC、最大呼气中期流量(PEF 25%～75%)与正常预计值比较有显著性差异，均P<0.01。结论：深圳地区儿童哮喘与外源性过敏原密切相关，肺功能仪测定儿童哮喘的肺功能变化有助于评估哮喘的发病情况。     

哮喘患儿支气管舒张试验与哮喘控制水平的相关性分析

目的 探讨支气管舒张试验(BDT)与儿童哮喘控制水平的关系.方法 选取2016年3月至2018年3月门诊就诊的5～14岁哮喘患儿153例,根据是否为特应性体质分为过敏组(79例)和非过敏组(74例),分析两组患儿BDT与儿童哮喘控制测试量表(C-ACT)评分的相关性.结果 过敏组患儿除用力肺活量占预计值的百分比、呼气峰...     

家庭环境香烟烟雾暴露对哮喘患儿疾病控制状况的影响

目的 了解家庭环境香烟烟雾暴露(ETS)与哮喘患儿疾病控制情况的关系.方法 通过病例对照研究方法,对83名ETS和80名非ETS的哮喘儿童进行为期1年的随访,比较两组患儿的儿童哮喘控制测试(childhood asthma control test,C-ACT)评分良好(＞19分)的例次,哮喘控制用药增加天数、急救用药使用天数,以及尿cotinine含量.结果 ETS患儿C-ACT＞19分802例次,占总C-ACT评分例次的80.5%;非ETS患儿 C-ACT＞9分921例次,占95.9%,两组患儿的哮喘控制状况差异无统计学意义(P＜0.05);ETS患儿的尿cotinine含量、支气管扩张剂使用天数、吸入激素增加天数、全身激素使用天数也均明显多于非ETS患儿(P均＜0.05).ETS患儿以尿cotinine含量分为重度(＞4 ng/ml)和轻度(≤4 ng/ml),其中重度ETS患儿的C-ACT＞19分例次低于轻度ETS患儿,而支气管扩张剂使用天数、吸入激素增加天数、全身激素使用天数也均明显多于轻度ETS患儿,差异均有统计学意义(P均＜0.05).结论 ETS是儿童哮喘控制不良的重要危险因素之一.     

标准化尘螨变应原治疗支气管哮喘及变应性鼻炎患儿随访分析

目的 评价标准化尘螨变应原治疗儿童支气管哮喘(哮喘)及变应性鼻炎的近期及远期疗效.方法 回顾性收集2006年2月-2007年8月在本院应用标准化屋尘螨制剂(安脱达)治疗2.5～3.0 a、且资料完整的患儿共55例,治疗结束后定期随访,分别在3个月、6个月、1.0 a、1.5 a时随访,比较治疗前、治疗结束时、随访时儿童哮喘控制测试(C-ACT)得分、鼻部症状评分、哮喘症状评分、药物评分、呼气峰流速(PEF)值、PEF%,并在治疗结束时由患儿自我评价鼻炎及哮喘疗效.结果 55例完成3个月及6个月随访,39例完成1.0 a随访,25例完成1.5 a随访.55例患儿脱敏治疗前和脱敏治疗结束时C-ACT、鼻部症状评分、哮喘症状评分、用药评分、PEF、PEF%比较,差异均有统计学意义(Pa＜0.05);55例患儿脱敏治疗结束时和随访3个月、6个月、1.0 a、1.5 a时C-ACT、鼻部症状评分、哮喘症状评分、药物评分比较,差异均无统计学意义(Pa＞0.05).结论 标准化屋尘螨变应原治疗哮喘具有良好的近期疗效和远期疗效.     

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??Abstract?? Objective Toinvestigatethe correlation among exhalednitric oxide??lung function and Asthma Control Test inasthmatic childrenand the clinicalsignificance. Methods A total of 136 cases of asthmatic children aged 5 to 15 years old were recruited from Shengjing Hospital of China Medical University.The fraction of exhaled nitric oxide?? lung function and ACTscore were measured??and the correlation among them was analyzed. Results Negative correlation was found between FeNOand ACT??r= -0.251??P<0.005??.Negative correlation was found between FeNOandFEV1/FVC of lung function??r=-0.206??P<0.05????but not FEV1or PEF.Positive correlation was found betweenACT scoreandFEV1/FVC of lung function ??r=0.242??P<0.01???? but not FEV1or PEF. Conclusion For all subjects??FeNO is negatively correlated with ACT score and FEV1/FVC.ACT is positively correlated with FEV1/FVC.When the subjects are grouped??the three don’t have stable correlations.FeNO is a good biomarker to evaluate the airway inflammation of asthmatic children.ACT score evaluates the level of asthma control in children.Lung function evaluates airway obstruction.FeNO??lung function andACTare different measurements that evaluate asthma in different ways.None of them can be used instead of another in clinical practice??and they are complementary.Combinedapplicationscan effectivelyimprove the diagnosis??treatment and asthmacontrol inasthmatic children.     

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??Abstract?? Objective To find out the fractional exhaled nitric oxide?? FENO?? in different control level and the relationship of FENO with childhood asthma control test ??C-ACT?? and bronchial provocation test??BPT??. Methods Totally 48 asthmatic children who underwent routine checkups since March 2011 through September 2011 were enrolled in the study. The patients completed the detection of FENO?? they also underwent pulmonary function test??PFT???? bronchial provocation test ??BPT??and C-ACT. Those indexes and relationships were analyzed in different control groups. Results The geometrical mean FENO of asthmatic children was ??22.5 ± 2.0?? × 10-9 mol/L. Uncontrolled group had higher FENO than controlled group and partly controlled group?? and FENO was slightly related to FEV1% Pred??so did PC20??but no relevance had been found between FENO?? C-ACT or PC20. Conclusion FENO can be an useful tool in managing asthma when used together with C-ACT??PFT and BPT.     

General and disease-specific scales in children with asthma and their parents

Objective

To investigate and compare the efficiency of general and disease-specific life quality scales in children with asthma.

Methods

Children with asthma, and their parents completed the Childhood Asthma Control Test (C-ACT), Pediatric Asthma Quality of Life Questionnaire (PAQLQ), Pediatric Quality of Life Inventory (PedsQL), and also underwent spirometry.

Results

82 children (55 males) with a median (IQR) age of 10.1 (8.9-10.5) years were included. C-ACT, PAQLQ and PedsQL child scores were significantly higher in children with controlled asthma.

Conclusions

Quality of life in children, assessed using diseasespecific quality of life measures, is better for children with good asthma control.

     

Pediatric asthma quality of life questionnaire (PAQLQ): Validation among asthmatic children in Thailand

Quality of life (QoL) is an important consideration among asthma sufferers. The Pediatric Asthma Quality of Life Questionnaire (PAQLQ) is one of the most widely used instruments for measuring health-related QoL in children with asthma. The standardized version of PAQLQ contains 23 questions in three domains, i.e., activity limitation, symptoms and emotional function. The objective of this study was to validate the Thai-translated version of the PAQLQ. The study design consisted of a five-week single cohort study. Patients recorded symptoms, and peak expiratory flow rate (PEFR) each morning and evening during the first and fifth week of the study in asthma diary. At each clinic visit, a trained-interviewer administered the PAQLQ and performed spirometric measurements. Fifty-one children, ages between 7 and 17 yr participated in the study. Scores from the asthma diary were used to classify patients into stable vs. unstable groups. The construct validity of the questionnaire was confirmed in both cross-sectional and longitudinal studies by demonstrating correlations between various PAQLQ domains with clinical asthma parameters (asthma diary, beta-agonist use and PEFR). There was high internal consistency for scores of the three domains (Cronbach's alpha-coefficient = 0.83-0.95). For those with stable asthma, the reliability of PAQLQ was good for the rating scale (intra-class correlation coefficient--ICC = 0.84) and for total score (alpha = 0.97) indicating high reproducibility of the PAQLQ. The significant difference of changes QoL scores between stable and unstable groups was observed in all domains. We conclude that the Thai version of PAQLQ is valid and reliable for implementing in Thai children with asthma.     

Asthma control in the quality of life levels of asthmatic patients’ caregivers: a systematic review with meta-analysis and meta-regression

ObjectiveTo perform a systematic review with meta-analysis and meta-regression to correlate the total scores of asthma control with the increase in the total scores of health-related quality of life levels of parents of asthmatic children.SourcesThe search was carried out in the following databases: PubMed (MEDLINE); Embase and ScienceDirect (Elsevier); SciELO and LILACs (Bireme) in June 2017. The included studies assessed asthma control through the Asthma Control Questionnaire (ACQ), Asthma Control Test (C-ACT/ACT), and Global Initiative for Asthma (GINA) questionnaires, whereas the Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ) was applied to assess the HRQoL of parents and family members.Summary of the findings294 articles were evaluated in the selected databases, of which (n = 38) were excluded for duplicity; (n = 239) after the reading of the titles and abstracts and (n = 5) after reading the studies in full, totaling 12 studies eligible for the meta-analysis. Of the 12 eligible articles, 11 (92%) were published in the last five years, and evaluated children and adolescents aged 1–20 years, totaling 2804 samples. In the evaluation of the correlation between the disease control scores by ACQ and C-ACT/ACT, the results were satisfactory for both ACQ analyses [R²: ?0.88; p < 0.001], and for C-ACT/ACT [R²: 0.82; p < 0.001].ConclusionsThe results show that asthma control levels can influence the total HRQoL scores of parents or relatives of children and adolescents with asthma.     

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??Objective To investigate the efficacy and safety of fluticasone propionate??FP?? inhalation solution compared with oral prednisone??PRE?? in Chinese pediatric and adolescent subjects??aged 4 to 16 years?? with an acute exacerbation of asthma. Methods This was a randomized?? double-blind?? double-dummy?? active-controlled?? parallel-group?? multi-center??non-inferiority study involving subjects??aged 4 to 16 years old??inclusive?? with an acute exacerbation of asthma??to compare the morning Peak expiratory flow??AM PEF??. Oral PRE once daily 2 mg/??kg·d????up to 40 mg/d for 4 d??then 1 mg/??kg·d?? or half of the original dose??up to 20 mg/d for 3 d?? for 7 d. The study comprised a 7-d treatment period and a 14-d follow-up period??. Results In terms of the primary efficacy endpoint mean AM PEF??the low limit of 95% CI was -9.64 L/min??which was above the pre-defined non-inferiority margin -12 L/min. Conclusion??FP inhalation solution was shown to be non-inferior to oral PRE in the treatment of acute exacerbation of asthma in Chinese pediatric and adolescent patients. FP inhalation solution demonstrates good safety.     

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??Objective To explore the effect of meteorological environment warning forecast technology intervention on the symptoms and quality of life in asthmatic children. Method A total of one hundred and sixty six children with asthma?? aged 2-12??were recruited from the community in Shanghai from Jan. 2011 to Dec. 2011. They were divided into 2 groups?? intervention group ??n = 80?? and matched control group ??n = 86??. Finally?? 71 cases in intervention group and 63 cases in control group finished the follow-up process completely. Children-the Asthma Control Test ??C-ACT?? and Pediatric Quality of Life Inventory were done before and after intervention in both groups. The intervention group accepted meteorological environment warning forecast technology intervention by short message service and E-mail everyday for 3 months. Results There was no significant difference between the intervention group and the control group in the general condition except the family structure??P??0.05??. The meteorological environment warning forecast technology intervention increased the physiological function?? emotional function and school performance of the intervention group ??P??0.05???? A multivariate logistic regression model showed there was no significant difference of C-ACT score ??F = 0.263??P = 0.610?? in the two groups. Conclusion Asthmatic children are told the risk of asthma attacks and receive appropriate protection by using meteorological environment warning forecast technology. It can prevent asthma acute attack??alleviate the symptoms and improve physiological function and the quality of life.