中重度持续性哮喘儿童吸入ICS减量停药的随访研究

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。

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

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 50～100μg 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 recurrences. 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 (x2=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.