根据气道高反应性指导儿童哮喘的长期治疗：一项随机对照研究
2008/02/05
根据“最佳哮喘控制”而制定的儿童哮喘管理计划，仅取得了有限的成功，未能尽如人意。为此人们提出了以气道高反应性（airway hyperresponsiveness, AHR）作为参照标准的治疗策略。确定根据AHR而制定的治疗策略能否更有效地增加无症状日和改善哮喘患儿的肺功能，Nuijsink等进行了一项为期2年的多中心、双盲、平行、随机研究。
研究在210例中度变应性哮喘患儿（6～16岁）中进行。患儿随机分为两组：以AHR和症状评分综合指导的治疗策略（AHR策略）与单纯以症状为指导的传统策略（传统策略）。每3个月1次随访，评估症状评分、测定FEV1、胆碱激发结果，并根据分组分别根据症状评分（传统策略组）或AHR和症状评分（AHR策略组）调整药物剂量（氟替卡松/沙美特罗）。2年后，两组间无症状日的百分数无统计学差异。但AHR组支气管舒张剂前FEV1比传统策略组更高(2.3%预计值)，这完全是由于有91例AHR患者的症状评分较低。
作者认为，虽然根据AHR的治疗不能改善无症状日，但能提高变应性哮喘儿童支气管舒张剂前FEV1，尤其对那些具有AHR但症状评分较低的患者更适合。
（韩伟 青岛大学附属青岛市立医院呼吸科 266071 摘译）
（Eur Respir J 2007; 30: 457–466）
Long-term asthma treatment guided byairway hyperresponsiveness in children:a randomised controlled trial
M. Nuijsink*, W.C.J. Hop#, P.J. Sterk", E.J. Duiverman+ andJ.C. de Jongste1
on behalf of the Children Asthma Therapy Optimal (CATO) Study Groupe
ABSTRACT: Management plans for childhood asthma show limited success in optimising asthma control. The aim of the present study was to assess whether a treatment strategy guided by airway hyperresponsiveness (AHR) increased the number of symptom-free days and improved lung function in asthmatic children, compared with a symptom-driven reference strategy.
In a multicentre, double-blind, parallel-group, randomised, 2-yr intervention trial, 210 children (aged 6–16 yrs) with moderate atopic asthma, selected on the basis of symptom scores and/or the presence of AHR, were studied. At 3-monthly visits, symptom scores, forced expiratory volume in one second (FEV1) and methacholine challenge results were obtained, and medication (five levels of fluticasone with or without salmeterol) adjusted according to algorithms based on symptom score (reference strategy, n5104) or AHR and symptom score (AHR strategy, n5102). After 2 yrs, no difference was found in the percentage of symptom-free days between treatment strategies. Pre-bronchodilator FEV1 was higher in the AHR strategy (2.3% predicted). This was entirely explained by a gradual worsening of FEV1 in a subgroup of 91 hyperresponsive children enrolled with low symptom scores (final difference between study arms was 6%). Asthma treatment guided by airway hyperresponsiveness showed no benefits in terms of number of symptom-free days, but produced a better outcome in terms of pre-bronchodilator forced expiratory volume in one second in allergic asthmatic children, especially those characterised by low symptom scores despite airway hyperresponsiveness.
Nuijsink M. , Hop W.C.J., Sterk P.J., et al. Eur Respir J 2007; 30: 457–466
