哮喘联盟

   摘要
   背景：当标准剂量的吸入糖皮质激素（ICS）无法控制年龄>4岁儿童的症状时，指南建议增加一种长效β2受体激动剂（LABA），如果症状持续，其他的治疗方案也是可用的。
   目的：旨在确定使用LABAs升级治疗的患儿比例以及描述未使用LABAs升级治疗的患儿特征。
   方法：在1999年到2011年间，对5～12岁的接受ICS治疗的哮喘患儿进行研究，找出从使用ICS单药治疗到开始升级治疗的患儿。数据源自临床实践研究数据链和优化患者护理研究数据库。
   结果：10793例患儿使用了升级治疗，其中6252例儿童（58％）使用ICS的剂量增加，3436例（32％）儿童引入LABA治疗（包括1107例用固定剂量组合吸入器（FDC）取代了ICS吸入器），1105例儿童（10％）增加白三烯受体拮抗剂（LTRA）治疗。与接受LABA升级治疗的儿童相比，其他患儿更小并且使用ICS和缓解药物的剂量更低。ICS剂量的增加更可能发生于肥胖儿童；LTRA治疗更可能发生于患有鼻炎并用抗生素治疗的儿童。与FDC相比，使用单独的LABA吸入器升级治疗更可能发生在接受较低剂量口服类固醇治疗的较小的肥胖儿童。
   结论：接受ICS治疗的哮喘患儿升级治疗1/3使用了LABA。接受除LABA以外治疗的儿童具有不同的特征，因此处方医师需根据临床情况调整治疗方法。
 

（杨冬 审校）
 NPJ Prim Care Respir Med. 2015 Jun 11;25:15041. doi: 10.1038/npjpcrm.2015.41.

 

Initial step-up treatment changes in asthmatic children already prescribed inhaled corticosteroids: a historical cohort study.
 

Turner SW1, Richardson K2, Burden A2, Thomas M3, Murray C4, Price D2.
 

Abstract
BACKGROUND:When standard doses of inhaled corticosteroids (ICS) fail to control symptoms in children aged >4 years, guidelines recommend the addition of a long-acting β2-agonist (LABA), with other treatment options being available if symptoms persist.
AIMS:To determine the proportion of initial 'step-up' episodes where LABAs were prescribed and to describe characteristics of individuals not stepped up with LABA.
METHODS:Between 1999 and 2011, initial step-up episodes from ICS monotherapy were identified in children aged 5-12 years with asthma and in receipt of ICS. Data sources were the Clinical Practice Research Datalink and Optimum Patient Care Research Database.
RESULTS:Initial step-up episodes were identified in 10,793 children. ICS dose was increased in 6,252 children (58%), LABA was introduced in 3,436 (32%; including 1,107 where fixed dose combination inhaler (FDC) replaced the ICS inhaler), and leukotriene receptor antagonist (LTRA) was added in 1,105 (10%). Compared with children stepped up to any LABA, others were younger and prescribed lower doses of ICS and reliever medication. ICS dose increase was more likely in obese children and LTRA prescribing was more likely in children with rhinitis and in receipt of antibiotics. Compared with FDC, step-up to separate LABA inhaler was more likely in younger, obese children who were using less oral steroids.
CONCLUSIONS:One-third of initial step-up episodes in children with asthma treated with ICS are to add LABA. Different characteristics of children prescribed therapies other than LABA suggest that prescribers tailor treatment in some clinical settings.
 

NPJ Prim Care Respir Med. 2015 Jun 11;25:15041. doi: 10.1038/npjpcrm.2015.41.