儿童哮喘缓解期维持临床控制的干预研究

目的探讨哮喘缓解期儿童伴发急性上呼吸道感染（AURI）时维持临床控制的干预措施。方法选取100例达到临床控制的哮喘儿童，随机分为观察组和对照组，均以最低剂量吸入性糖皮质激素和长效β2受体激动剂复合制剂（ICS/LABA）每晚吸入维持临床治疗。伴发AURI时均予常规处理；观察组除常规处理外同时给予早期短期升级治疗，即在维持治疗基础上每日早晨加吸等量ICS/LABA复合制剂，维持升级治疗7~10 d。两组急性发作时均根据其病情严重程度按哮喘指南诊治。治疗3、6、9、12个月后观察两组哮喘控制水平、哮喘急性发作严重程度、肺功能指标变化和不良事件发生情况等。结果治疗3、6、9、12个月各随访时间点，观察组哮喘控制率均在90%以上，对照组为80%左右，两组控制率比较差异有统计学意义（P < 0.05）。各随访时间点观察组哮喘急性发作严重程度明显低于对照组（P < 0.05）。与对照组相比，观察组肺功能大、小气道指标均明显改善（P < 0.05）。与对照组相比，观察组吸入糖皮质激素量以及对家庭生活的影响均明显减少（P < 0.05）。结论哮喘缓解期儿童伴发AURI时早期短期升级治疗可预防哮喘急性发作，提高哮喘控制率，改善肺功能。

Intervention measures for maintenance of clinical control in the remission stage of childhood asthma

Objective To explore the intervention measures to maintain clinical control in children with asthma in the remission stage when concomitant with acute upper respiratory infection (AURI). Methods A total of 100 asthmatic children who had achieved clinical control were randomly divided into observation group and control group. The two groups were both treated with a combination of inhaled corticosteroids and long-acting β2 receptor agonist (ICS/LABA) at the lowest dose every night. Conventional therapies were used for the two groups when suffering from AURI. In addition to conventional therapies, the observation group was given early short-term upgrade therapy, i.e., on the basis of maintenance therapy, the same amount of ICS/LABA complex preparation was inhaled every morning, which lasted for 7-10 days. Both groups were treated following asthma guidelines according to the severity of the disease at the time of acute attacks. The control rate of asthma, severity of acute attacks, changes in pulmonary function indices, and occurrence of adverse events were evaluated after 3, 6, 9, and 12 months of treatment. Results At each time point of follow-up, the rate of asthma control in the observation group was significantly higher than that in the control group (90% vs 80%; P < 0.05). The severity of acute attacks in the observation group was significantly lower than that in the control group at all follow-up time points (P < 0.05). Compared with the control group, the observation group had significantly improved pulmonary function indices of large and small airways (P < 0.05) and significantly reduced mean amount of inhaled glucocorticoids and impact on family life (P < 0.01). Conclusions Early short-term upgrade therapy for children with asthma in the remission stage when concomitant with AURI can prevent acute attacks of asthma, raise the rate of asthma control and improve pulmonary function.