哮喘患儿早期糖皮质激素治疗不能改善10岁时的肺功能
2010/02/23
早期吸入性糖皮质激素（ICS）治疗对儿童期肺功能发育的作用尚存在争议。基于出生时肺功能，本试验研究早期ICS治疗是否会影响10岁时儿童的肺功能。
对参与奥斯陆环境与儿童哮喘研究的614/802名出生时检测过肺功能的儿童（平均年龄10.9 ±0.9岁）进行为期10年的随访研究，研究对象信息包括出生时2岁和10岁时通过父母面谈获得的ICS治疗相关信息（124名儿童有哮喘史）。主要终点为10岁时第1秒用力呼气量（FEV1）最佳值（％预测值和Z评分）及呼气中段流量。主要相关因子包括从未、过去和目前使用ICS及出生时潮气流量-体积比（tPTEF/tE）[到达呼气峰流速时间(tPTEF)和总呼气时间（tE）]Z评分。11.9％的儿童使用ICS治疗，其中71.6％当前患有哮喘。从出生至10岁，ICS治疗并未显著影响肺功能。在0～3岁期间或0～3岁后接受ICS治疗、3岁后或目前接受ICS治疗相比无ICS治疗的儿童FEV1最佳值（Z评分）和呼气中段流量无显著性差异。肺功能变化中一半与年龄、哮喘史及出生时tPTEF/tE有关。ICS治疗（10岁时每8个儿童中有一个）并不能显著改善出生至10岁儿童的肺功能。
（苏楠 审校）
Pediatr Allergy Immunol. 2009 Nov 13. [Epub ahead of print]
Lung function at 10 yrs is not improved by early corticosteroid treatment in asthmatic children.
Lødrup Carlsen KC, Devulapalli CS, Mowinckel P, Håland G, Munthe-Kaas MC, Carlsen KH.
Lung function at 10 yrs is not improved by early corticosteroid treatment in asthmatic children. Pediatr Allergy Immunol 2009. (c) 2009 John Wiley & Sons A/S
Early intervention with inhaled corticosteroid (ICS) treatment for lung function development in childhood is debated. In view of lung function at birth, we aimed to assess if early use of ICS influenced lung function at 10 yrs of age. A 10-yr follow-up study of 614/802 children (mean age 10.9 +/- 0.9 yrs) with lung function measurements at birth in the Environment and Childhood Asthma study in Oslo included information on ICS treatment (124 with history of asthma) obtained at 2 and 10 yrs by parental interviews. Main outcomes at 10 yrs were the best values (% predicted and Z-scores) of forced expiratory volume in 1 s (FEV(1)) and mid-expiratory flow. The main explanatory factors were never, past or current use of ICS and Z-scores of the tidal flow-volume ratio t(PTEF)/t(E) [time to peak expiratory flow (t(PTEF)) and total expiratory time (t(E))] at birth. ICS treatment, reported by 11.9% of children in the population sample and 71.6% with current asthma, did not significantly influence lung function from birth to 10 yrs. The best values (and Z-scores) of FEV(1), and mid-expiratory flow were similar (p > 0.1) in subjects receiving ICS during and after 0-3 yrs of age, after 3 yrs only or currently compared with steroid naïve children. Almost half of the change in lung function 0-10 yrs was explained by gender, a history of asthma and t(PTEF)/t(E) at birth. ICS treatment for asthma, reported in every eighth child by age 10 yrs, did not significantly improve lung function from birth to 10 yrs.
Lødrup Carlsen KC, Devulapalli CS, Mowinckel P, et al. Pediatr Allergy Immunol. 2009 Nov 13. [Epub ahead of print]
对参与奥斯陆环境与儿童哮喘研究的614/802名出生时检测过肺功能的儿童（平均年龄10.9 ±0.9岁）进行为期10年的随访研究，研究对象信息包括出生时2岁和10岁时通过父母面谈获得的ICS治疗相关信息（124名儿童有哮喘史）。主要终点为10岁时第1秒用力呼气量（FEV1）最佳值（％预测值和Z评分）及呼气中段流量。主要相关因子包括从未、过去和目前使用ICS及出生时潮气流量-体积比（tPTEF/tE）[到达呼气峰流速时间(tPTEF)和总呼气时间（tE）]Z评分。11.9％的儿童使用ICS治疗，其中71.6％当前患有哮喘。从出生至10岁，ICS治疗并未显著影响肺功能。在0～3岁期间或0～3岁后接受ICS治疗、3岁后或目前接受ICS治疗相比无ICS治疗的儿童FEV1最佳值（Z评分）和呼气中段流量无显著性差异。肺功能变化中一半与年龄、哮喘史及出生时tPTEF/tE有关。ICS治疗（10岁时每8个儿童中有一个）并不能显著改善出生至10岁儿童的肺功能。
（苏楠 审校）
Pediatr Allergy Immunol. 2009 Nov 13. [Epub ahead of print]
Lung function at 10 yrs is not improved by early corticosteroid treatment in asthmatic children.
Lødrup Carlsen KC, Devulapalli CS, Mowinckel P, Håland G, Munthe-Kaas MC, Carlsen KH.
Lung function at 10 yrs is not improved by early corticosteroid treatment in asthmatic children. Pediatr Allergy Immunol 2009. (c) 2009 John Wiley & Sons A/S
Early intervention with inhaled corticosteroid (ICS) treatment for lung function development in childhood is debated. In view of lung function at birth, we aimed to assess if early use of ICS influenced lung function at 10 yrs of age. A 10-yr follow-up study of 614/802 children (mean age 10.9 +/- 0.9 yrs) with lung function measurements at birth in the Environment and Childhood Asthma study in Oslo included information on ICS treatment (124 with history of asthma) obtained at 2 and 10 yrs by parental interviews. Main outcomes at 10 yrs were the best values (% predicted and Z-scores) of forced expiratory volume in 1 s (FEV(1)) and mid-expiratory flow. The main explanatory factors were never, past or current use of ICS and Z-scores of the tidal flow-volume ratio t(PTEF)/t(E) [time to peak expiratory flow (t(PTEF)) and total expiratory time (t(E))] at birth. ICS treatment, reported by 11.9% of children in the population sample and 71.6% with current asthma, did not significantly influence lung function from birth to 10 yrs. The best values (and Z-scores) of FEV(1), and mid-expiratory flow were similar (p > 0.1) in subjects receiving ICS during and after 0-3 yrs of age, after 3 yrs only or currently compared with steroid naïve children. Almost half of the change in lung function 0-10 yrs was explained by gender, a history of asthma and t(PTEF)/t(E) at birth. ICS treatment for asthma, reported in every eighth child by age 10 yrs, did not significantly improve lung function from birth to 10 yrs.
Lødrup Carlsen KC, Devulapalli CS, Mowinckel P, et al. Pediatr Allergy Immunol. 2009 Nov 13. [Epub ahead of print]
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吸入糖皮质激素后未控制的儿童哮喘的升级治疗
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