难治性重症哮喘：一种鉴别儿童重症抵抗性哮喘的推荐方法
2010/12/17
摘要
难治性重症哮喘（PA）患儿，或者由于存在恶化因素，导致治疗困难；或者出现了对治疗的严重抵抗。本试验对学龄期PA儿童进行队列研究，比较这些儿童与年龄相匹配的、哮喘得到控制（CA）的儿童之间的差异。描述PA儿童的特征，鉴别出那些重症抵抗性哮喘的患儿。本试验为一项横断面、多中心研究，比较患儿持续性哮喘的不同表现，其中PA被定义为尽管采用了GINA 推荐的4级治疗，哮喘仍未得到有效控制。方案包括问卷调查、肺活量测定、乙酰甲胆碱激发试验、呼出气和鼻腔呼气的一氧化氮含量（FeNO）检测、血清检测炎症标志物和过敏症检查，以及对鼻窦和肺部进行CT检查（仅限于PA组）。在54名PA患儿中，61%的患者存在对治疗的抵抗，其余患儿因为存在恶化因素而使治疗困难。与39名CA患儿相比，PA患儿其父母哮喘发生率较高(P= 0.003)，其社会经济地位较低(P= 0.01)，体力活动较少(P= 0.04)，共患鼻结膜炎的比率高(P= 0.01)。此外，PA患儿其FEV1较低(P= 0.02)，支气管高反应性比例增加(P= 0.01)，但过敏症的发生率(P= 0.81)和FeNO(P= 0.16)在两组之间未见显著差异。这项非侵入性的检查方案，包括标准化的和详细的临床特征，可以对PA患儿的主要特征进行鉴别，并且有助于鉴别对治疗抵抗的哮喘患儿。
（苏楠 审校）
Pediatr Allergy Immunol. 2010 Sep 30. doi: 10.1111/j.1399-3038.2010.01098.x.
Problematic severe asthma: A proposed approach to identifying children who are severely resistant to therapy.
Konradsen JR, Nordlund B, Lidegran M, Pedroletti C, Grönlund H, Van Hage M, Dahlen B, Hedlin G; In Cooperation with the Swedish network of Pediatric Allergists, Severe Asthma Network.
Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden GA2LEN, Global Allergy and Asthma European Network Department of Medicine, Clinical Immunology and Allergy Unit, Karolinska Institutet and University Hospital, Stockholm, Sweden Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden.
Abstract
Children with problematic severe asthma (PA) are either difficult to treat because of the presence of aggravating factors or else severely resistant to therapy. We investigated a cohort of school-aged children with PA and compared these children to age-matched peers with controlled persistent asthma (CA). The aims were to characterize features of children suffering from PA and identify children who were severely resistant to therapy. In this cross-sectional, multicenter comparison of children with different manifestations of persistent asthma, PA was defined as insufficient asthma control despite level 4 treatment, according to GINA. The protocol included questionnaires, spirometry, methacholine provocation, measurement of fraction of nitric oxide in exhaled (FE(NO) ) and nasal air, blood sampling for inflammatory biomarkers and atopy, and computerized tomography of sinuses and lungs (in the PA group only). Of the 54 children with PA, 61% had therapy-resistant asthma, with the remaining being difficult to treat because of identified aggravating factors. Children with PA more often had parents with asthma (p 0.01), came from families with a lower socioeconomic status (p = 0.01), were less physically active (p = 0.04), and had more comorbidity with rhinoconjunctivitis (p = 0.01) than did the 39 children with CA. The former also exhibited lower FEV1 values (p = 0.02) and increased bronchial hyper-responsiveness (p = 0.01), but there were no differences in atopy (p = 0.81) or FENO (p = 0.16). A non-invasive protocol, involving a standardized and detailed clinical characterization, revealed distinguishing features of children with PA and enabled the identification of children with therapy-resistant asthma.
Pediatr Allergy Immunol. 2010 Sep 30. doi: 10.1111/j.1399-3038.2010.01098.x.
难治性重症哮喘（PA）患儿，或者由于存在恶化因素，导致治疗困难；或者出现了对治疗的严重抵抗。本试验对学龄期PA儿童进行队列研究，比较这些儿童与年龄相匹配的、哮喘得到控制（CA）的儿童之间的差异。描述PA儿童的特征，鉴别出那些重症抵抗性哮喘的患儿。本试验为一项横断面、多中心研究，比较患儿持续性哮喘的不同表现，其中PA被定义为尽管采用了GINA 推荐的4级治疗，哮喘仍未得到有效控制。方案包括问卷调查、肺活量测定、乙酰甲胆碱激发试验、呼出气和鼻腔呼气的一氧化氮含量（FeNO）检测、血清检测炎症标志物和过敏症检查，以及对鼻窦和肺部进行CT检查（仅限于PA组）。在54名PA患儿中，61%的患者存在对治疗的抵抗，其余患儿因为存在恶化因素而使治疗困难。与39名CA患儿相比，PA患儿其父母哮喘发生率较高(P= 0.003)，其社会经济地位较低(P= 0.01)，体力活动较少(P= 0.04)，共患鼻结膜炎的比率高(P= 0.01)。此外，PA患儿其FEV1较低(P= 0.02)，支气管高反应性比例增加(P= 0.01)，但过敏症的发生率(P= 0.81)和FeNO(P= 0.16)在两组之间未见显著差异。这项非侵入性的检查方案，包括标准化的和详细的临床特征，可以对PA患儿的主要特征进行鉴别，并且有助于鉴别对治疗抵抗的哮喘患儿。
（苏楠 审校）
Pediatr Allergy Immunol. 2010 Sep 30. doi: 10.1111/j.1399-3038.2010.01098.x.
Problematic severe asthma: A proposed approach to identifying children who are severely resistant to therapy.
Konradsen JR, Nordlund B, Lidegran M, Pedroletti C, Grönlund H, Van Hage M, Dahlen B, Hedlin G; In Cooperation with the Swedish network of Pediatric Allergists, Severe Asthma Network.
Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden Department of Women’s and Children’s Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden GA2LEN, Global Allergy and Asthma European Network Department of Medicine, Clinical Immunology and Allergy Unit, Karolinska Institutet and University Hospital, Stockholm, Sweden Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden.
Abstract
Children with problematic severe asthma (PA) are either difficult to treat because of the presence of aggravating factors or else severely resistant to therapy. We investigated a cohort of school-aged children with PA and compared these children to age-matched peers with controlled persistent asthma (CA). The aims were to characterize features of children suffering from PA and identify children who were severely resistant to therapy. In this cross-sectional, multicenter comparison of children with different manifestations of persistent asthma, PA was defined as insufficient asthma control despite level 4 treatment, according to GINA. The protocol included questionnaires, spirometry, methacholine provocation, measurement of fraction of nitric oxide in exhaled (FE(NO) ) and nasal air, blood sampling for inflammatory biomarkers and atopy, and computerized tomography of sinuses and lungs (in the PA group only). Of the 54 children with PA, 61% had therapy-resistant asthma, with the remaining being difficult to treat because of identified aggravating factors. Children with PA more often had parents with asthma (p 0.01), came from families with a lower socioeconomic status (p = 0.01), were less physically active (p = 0.04), and had more comorbidity with rhinoconjunctivitis (p = 0.01) than did the 39 children with CA. The former also exhibited lower FEV1 values (p = 0.02) and increased bronchial hyper-responsiveness (p = 0.01), but there were no differences in atopy (p = 0.81) or FENO (p = 0.16). A non-invasive protocol, involving a standardized and detailed clinical characterization, revealed distinguishing features of children with PA and enabled the identification of children with therapy-resistant asthma.
Pediatr Allergy Immunol. 2010 Sep 30. doi: 10.1111/j.1399-3038.2010.01098.x.
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鼻内给予皮质类固醇对伴有轻度哮喘的过敏性鼻炎患者哮喘控制和生活质量的影响
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