哮喘联盟

   摘要
   背景与目的：使用吸入性糖皮质激素(ICS)治疗的第一年可导致身高增长减慢，但是这种生长抑制效应不会持续至后续的治疗中。至于原因，可能与依从性的降低有关。本研究旨在评估儿童哮喘患者ICS实际累积暴露（用于客观评价依从性）与身高增长的关系。
   方法：本研究分析了99例2-13岁的青春期前儿童哮喘患者，这些患儿使用指南推荐的ICS剂量方案≥3个月，且随访1年内持续使用。运用电子监控设备评估ICS依从性，它可以计算出ICS实际累积暴露。分析一年以上ICS累积剂量与身高增长速度（通过身高SD评分的变化来评估）的关系。
   结果：1年以上中位数（四分位间距）依从性为84 (68-92) %。氟替卡松平均累积剂量为64.6 (SD, 27.8) mg，提示每日剂量为167 (SD, 7) µg。ICS累积剂量与身高生长速度呈负相关(r=-0.266; p=0.008)；多元回归模型中对年龄、性别进行校正后，结果无显著性意义(校正r=-0.188; p=0.066)。
   结论：按照指南推荐剂量的ICS治疗一年，依从性高者不会导致明显或相关的生长抑制。哮喘患儿应用ICS治疗依从性高者其生长不受影响至少持续1年。
 

（杨冬 审校）
ArchDisChild. 2015Dec7.pii:archdischild-2015-309654.doi:10.1136/archdischild-2015-309654. [Epub ahead of print]
 

Height growth in children with asthma treated with guideline-recommended dosages of fluticasone and electronically assessed adherence.
 

Wardenier NR1, Klok T2, de Groot EP3, Brand PL4.
 

Abstract
BACKGROUND AND AIMS:Inhaled corticosteroids (ICS) reduce growth during the first year of treatment, but this growth suppressing effect does not continue during further treatment. Decreasing adherence may play a role in explaining this. The aim of this study was to examine the relationship between cumulative real exposure (with objectively assessed adherence) to ICS and height growth in children with asthma.
METHODS:We investigated 99 prepubertal children with asthma, 2-13 years of age, who had been using ICS in guideline-recommended dosages for ≥3 months, and continued to do so during 1-year follow-up. ICS adherence was assessed by electronic monitoring devices, allowing calculation of true cumulative exposure to ICS. We analysed the relationship between cumulative ICS dose and height growth velocity (assessed as change in height SD score) over 1 year.
RESULTS:Median (IQR) adherence over 1 year was 84 (68-92) %. Mean cumulative fluticasone dose was 64.6 (SD, 27.8) mg, reflecting a daily dose of 167 (SD, 7) µg. The negative correlation between cumulative ICS dose and height growth velocity (r=-0.266; p=0.008) became non-significant after adjustment for age and sex in a multiple regression model (adjusted r=-0.188; p=0.066).
CONCLUSIONS:One year of ICS treatment in guideline-recommended dosages with high adherence did not result in significant or relevant growth suppression. Unaffected growth can be maintained for at least 1 year in children with asthma during ICS treatment with high adherence.
 

ArchDisChild. 2015Dec7.pii:archdischild-2015-309654.doi:10.1136/archdischild-2015-309654. [Epub ahead of print]