雾化吸入布地奈德与口服孟鲁司特治疗咳嗽变异性哮喘比较研究

目的:比较雾化吸入布地奈德混悬液与口服孟鲁司特治疗儿童咳嗽变异性哮喘(CVA)的疗效。方法:118例CVA患儿分为:A组40例,使用空气压缩泵雾化吸入布地奈德混悬液;B组40例,口服孟鲁司特;C组38例,口服氯雷他定。每组患儿每日做观察日记,记录日间、夜间咳嗽情况、可能出现的气喘、药物使用情况。治疗4周内每周随访1次,症状控制后每月随访1～2次,其间电话随访,若出现气喘,嘱门诊随访。随访时分别观察记录3组治疗后1、2、3、4、8、12周日间、夜间咳嗽症状,并进行总评分;治疗6个月后,评估哮喘控制情况,继续随访18个月,观察3组患儿2年内的复发情况;观察3组2年内出现喘息发作、转变成典型哮喘(CA)人数,并记录治疗过程中不良反应等。结果:三组有效控制率分别为97.5%、95%、18.4%,与C组比较,A、B组疗效差异有统计学意义(χ2=16.004,P<0.01)。A组与B组比较,差异无统计学意义(χ2=1.946,P>0.05)。三组治疗后1、2、3、4、8、12周,日间、夜间咳嗽症状总评分比较,A、B组在治疗的第1、2、3、4周,总评分较治疗前均有不同程度下降,在第2、3周,咳嗽评分A组较B组下降更明显,差异有统计学意义(P<0.05);三组患儿经治疗后2年内CVA复发及出现喘息人数,A、B组少于C组,而A组复发比率为7.5%,出现喘息比率为10%,少于B组的25%、35%,差异有统计学意义(χ2=8.467,P<0.05)。结论:压缩泵雾化吸入布地奈德混悬液和口服孟鲁司特比较,前者可更好、更快缓解临床症状,减少CVA复发,有效预防转变为典型哮喘,长远疗效优于口服孟鲁司特。

Clinical observation of nebulized budesonide and oral montelukast in the treatment of cough variant asthma

AIM: To compare the therapy effect of inhalation of budesonide suspension with oral montelukast in cough variant asthma(CVA) of children..METHODS: 118 cases of CVA were divided into group A(n=40),who were used air compression pump inhalation of budesonide suspension;group B(n=40),who were taken orally montelukast;group C(n=38),who were given loratadine by oral administration.Each group of children were done observation diary every day,recorded the cough,asthma and medication from day to night,followed up once a week in the treatment of 4 weeks,followed up 1-2 times once month after symptom controlled,telephone followed up during the period.If appeared asthma,outpatient was received follow-up.During the follow-up period,three groups were recorded respectively cough symptoms in day and night after treatment with 1,2,3,4,8,12 week and done total scores. After 6 months of treatment,we assessed the control condition of asthma.Continue to follow-up 18 months,we observed the recurrence of patients within 2 years and the numbers of wheezing episode and changed into typical asthma(CA) of three groups within 2 years,and recorded the adverse reaction during the treatment. RESULTS:The valid control rates of three groups were 97.5%,95%,18.4%,respectively.Compared with group C,the efficacy had significant difference in group A,group B(χ2=16.004,P<0.05).There was no significant difference between group A and group B(χ2=1.946,P>0.05).Compared with before treatment,the total scores was decreased in the treatment of 1,2,3,4 week in group A,group B;In the treatment of 2,3 week,cough score of group A was decreased obviously than that in group B,the difference was statistically significant(P<0.05);Three groups after treatment,the number of CVA recurrence and wheezing in group A,B was less than that in group C,and relapse rate of group A was 7.5%,wheezing ratio was 10%,while in group B were 25%,35%(χ2=8.467,P<0.05). CONCLUSION: Compare with take orally montelukast,compress aerosol inhalation budesonide can anesis clinical symptoms better and faster,reduce the recurrence of CVA,effective prevent into typical asthma,and the long-term efficacy is superior to oral montelukast.