学龄前高危哮喘患儿长期吸入糖皮质激素
2007/03/09
此研究表明长期吸入糖皮质激素不影响学龄前高危哮喘患儿的哮喘的发展。
（刘颖格 西安，第四军医大学西京医院呼吸内科?710032 摘译）
（ N Engl J Med 2006;354:1985-1997）
Long-Term Inhaled Corticosteroids in Preschool Children at High Risk for Asthma
Theresa W. Guilbert, M.D., Wayne J. Morgan, M.D., Robert S. Zeiger, M.D., Ph.D., David T. Mauger, Ph.D.,Susan J. Boehmer, M.A., Stanley J. Szefler, M.D., Ph.D., Leonard B. Bacharier, M.D., Robert F. Lemanske, Jr., M.D.,Robert C. Strunk, M.D., David B. Allen, M.D., Gordon R. Bloomberg, M.D., Gregory Heldt, M.D., Marzena Krawiec, M.D.,Gary Larsen, M.D., Andrew H. Liu, M.D., Vernon M. Chinchilli, Ph.D., Christine A. Sorkness, Pharm.D.,Lynn M. Taussig, M.D., and Fernando D. Martinez, M.D.
ABSTRACT
Background
It is unknown whether inhaled corticosteroids can modify the subsequent developmentof asthma in preschool children at high risk for asthma.
Methods
We randomly assigned 285 participants two or three years of age with a positive asthma predictive index to treatment with fluticasone propionate (at a dose of 88 μg twice daily) or masked placebo for two years, followed by a one-year period without study medication. The primary outcome was the proportion of episode-free days during the observation year.
Results
During the observation year, no significant differences were seen between the two groups in the proportion of episode-free days, the number of exacerbations, or lung function. During the treatment period, as compared with placebo use, use of the inhaled corticosteroid was associated with a greater proportion of episode-free days (P = 0.006) and a lower rate of exacerbations (P<0.001) and of supplementary use of controller medication (P<0.001). In the inhaled-corticosteroid group, as compared with the placebo group, the mean increase in height was 1.1 cm less at 24 months (P<0.001), but by the end of the trial, the height increase was 0.7 cm less (P = 0.008). During treatment, the inhaled corticosteroid reduced symptoms and exacerbations but slowed growth, albeit temporarily and not progressively.
Conclusions
In preschool children at high risk for asthma, two years of inhaled-corticosteroid therapy did not change the development of asthma symptoms or lung function during a third, treatment-free year. These findings do not provide support for a subsequent disease-modifying effect of inhaled corticosteroids after the treatment is discontinued.
