大部分夜间哮喘症状出现在哮喘急性发作期以外且与哮喘发病相关
2011/10/13
摘要
背景：虽然夜间觉醒有助于将哮喘严重程度和哮喘控制进行分类，但其临床价值尚未完全清楚。
目的：本试验旨在利用轻中度持续哮喘患儿研究需要沙丁胺醇治疗的哮喘夜间症状(NASRAs)的临床效应，这些患儿未处于口服需要皮质激素治疗的哮喘症状恶化期。
方法：285名年龄6～14岁的轻中度持续性哮喘患儿随机采用3种控制治疗方案中的一种进行治疗，完成每日症状日志记录，连续48周。基于日志的记录，分析NASRAs的频率和效应。
结果：72.2%的参与者至少出现一次NASRAs，24.3%的参与者中出现13次或更多次。大部分(81.3%)夜间哮喘症状出现在恶化期之外，而且与随后1天的下列事件相关：沙丁胺醇使用（56.9%的天数中使用沙丁胺醇之前出现夜间症状，仅18.1%的天数中沙丁胺醇使用之前无夜间症状，相对危险（RR：2.3; 95% CI, 2.2-2.4）、旷课(5.0% vs 0.3%; RR, 10.6; 95% CI, 7.8-14.4)和就诊(3.7% vs 0.2%; RR, 8.8; 95% CI, 6.1-12.5)。在哮喘急性发作期也有类似的发现(RR在沙丁胺醇使用上为1.7，旷课上为5.5，就诊上为4.9)。夜间哮喘症状不能预测哮喘恶化的发作。
结论：轻中度持续性哮喘、需要控制治疗的患儿中，需要沙丁胺醇治疗的哮喘夜间发作主要出现在哮喘恶化期之外。尽管该症状不能预测哮喘急性发作，但与夜间症状出后次日的沙丁胺醇使用增加、旷课和医院就诊相关。
（刘国梁 审校）
J Allergy Clin Immunol. 2011 Aug 18. [Epub ahead of print]
Most nocturnal asthma symptoms occur outside of exacerbations and associate with morbidity.
Horner CC, Mauger D, Strunk RC, Graber NJ, Lemanske RF Jr, Sorkness CA, Szefler SJ, Zeiger RS, Taussig LM, Bacharier LB; Childhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute.
Source
Department of Pediatrics, Washington University School of Medicine and St Louis Children’s Hospital, St Louis, Mo.
Abstract
BACKGROUND: Although nocturnal awakenings help categorize asthma severity and control, their clinical significance has not been thoroughly studied.
OBJECTIVE: We sought to determine the clinical consequences of nocturnal asthma symptoms requiring albuterol (NASRAs) in children with mild-to-moderate persistent asthma outside of periods when oral corticosteroids were used for worsening asthma symptoms.
METHODS: Two hundred eighty-five children aged 6 to 14 years with mild-to-moderate persistent asthma were randomized to receive one of 3 controller regimens and completed daily symptom diaries for 48 weeks. Diary responses were analyzed for the frequency and consequences of NASRAs.
RESULTS: NASRAs occurred in 72.2% of participants at least once, and in 24.3% of participants, they occurred 13 or more times. The majority (81.3%) of nocturnal symptoms occurred outside of exacerbation periods and were associated the next day with the following events: albuterol use (56.9% of days preceded by nocturnal symptoms vs 18.1% of days not preceded by nocturnal symptoms; relative risk [RR], 2.3; 95% CI, 2.2-2.4), school absence (5.0% vs 0.3%; RR, 10.6; 95% CI, 7.8-14.4), and doctor contact (3.7% vs 0.2%; RR, 8.8; 95% CI, 6.1-12.5). Similar findings were noted during exacerbation periods (RRs of 1.7 for albuterol use, 5.5 for school absence, and 4.9 for doctor contacts). Nocturnal symptoms did not predict the onset of exacerbations.
CONCLUSION:Nocturnal symptoms requiring albuterol in children with mild-to-moderate persistent asthma receiving controller therapy occurred predominantly outside of exacerbation periods. Despite being poor predictors of exacerbations, they were associated with increases in albuterol use, school absences, and doctor contacts the day after nocturnal symptom occurrences.
J Allergy Clin Immunol. 2011 Aug 18. [Epub ahead of print]
背景：虽然夜间觉醒有助于将哮喘严重程度和哮喘控制进行分类，但其临床价值尚未完全清楚。
目的：本试验旨在利用轻中度持续哮喘患儿研究需要沙丁胺醇治疗的哮喘夜间症状(NASRAs)的临床效应，这些患儿未处于口服需要皮质激素治疗的哮喘症状恶化期。
方法：285名年龄6～14岁的轻中度持续性哮喘患儿随机采用3种控制治疗方案中的一种进行治疗，完成每日症状日志记录，连续48周。基于日志的记录，分析NASRAs的频率和效应。
结果：72.2%的参与者至少出现一次NASRAs，24.3%的参与者中出现13次或更多次。大部分(81.3%)夜间哮喘症状出现在恶化期之外，而且与随后1天的下列事件相关：沙丁胺醇使用（56.9%的天数中使用沙丁胺醇之前出现夜间症状，仅18.1%的天数中沙丁胺醇使用之前无夜间症状，相对危险（RR：2.3; 95% CI, 2.2-2.4）、旷课(5.0% vs 0.3%; RR, 10.6; 95% CI, 7.8-14.4)和就诊(3.7% vs 0.2%; RR, 8.8; 95% CI, 6.1-12.5)。在哮喘急性发作期也有类似的发现(RR在沙丁胺醇使用上为1.7，旷课上为5.5，就诊上为4.9)。夜间哮喘症状不能预测哮喘恶化的发作。
结论：轻中度持续性哮喘、需要控制治疗的患儿中，需要沙丁胺醇治疗的哮喘夜间发作主要出现在哮喘恶化期之外。尽管该症状不能预测哮喘急性发作，但与夜间症状出后次日的沙丁胺醇使用增加、旷课和医院就诊相关。
（刘国梁 审校）
J Allergy Clin Immunol. 2011 Aug 18. [Epub ahead of print]
Most nocturnal asthma symptoms occur outside of exacerbations and associate with morbidity.
Horner CC, Mauger D, Strunk RC, Graber NJ, Lemanske RF Jr, Sorkness CA, Szefler SJ, Zeiger RS, Taussig LM, Bacharier LB; Childhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute.
Source
Department of Pediatrics, Washington University School of Medicine and St Louis Children’s Hospital, St Louis, Mo.
Abstract
BACKGROUND: Although nocturnal awakenings help categorize asthma severity and control, their clinical significance has not been thoroughly studied.
OBJECTIVE: We sought to determine the clinical consequences of nocturnal asthma symptoms requiring albuterol (NASRAs) in children with mild-to-moderate persistent asthma outside of periods when oral corticosteroids were used for worsening asthma symptoms.
METHODS: Two hundred eighty-five children aged 6 to 14 years with mild-to-moderate persistent asthma were randomized to receive one of 3 controller regimens and completed daily symptom diaries for 48 weeks. Diary responses were analyzed for the frequency and consequences of NASRAs.
RESULTS: NASRAs occurred in 72.2% of participants at least once, and in 24.3% of participants, they occurred 13 or more times. The majority (81.3%) of nocturnal symptoms occurred outside of exacerbation periods and were associated the next day with the following events: albuterol use (56.9% of days preceded by nocturnal symptoms vs 18.1% of days not preceded by nocturnal symptoms; relative risk [RR], 2.3; 95% CI, 2.2-2.4), school absence (5.0% vs 0.3%; RR, 10.6; 95% CI, 7.8-14.4), and doctor contact (3.7% vs 0.2%; RR, 8.8; 95% CI, 6.1-12.5). Similar findings were noted during exacerbation periods (RRs of 1.7 for albuterol use, 5.5 for school absence, and 4.9 for doctor contacts). Nocturnal symptoms did not predict the onset of exacerbations.
CONCLUSION:Nocturnal symptoms requiring albuterol in children with mild-to-moderate persistent asthma receiving controller therapy occurred predominantly outside of exacerbation periods. Despite being poor predictors of exacerbations, they were associated with increases in albuterol use, school absences, and doctor contacts the day after nocturnal symptom occurrences.
J Allergy Clin Immunol. 2011 Aug 18. [Epub ahead of print]
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