哮喘联盟

   来源：荷兰，阿姆斯特丹，医学学术中心，爱玛儿童医院儿童呼吸、过敏科

   摘要
   背景：高海拔综合治疗是儿童未控制的严重哮喘（PSA）的可能治疗选择。这个治疗可逐渐减少皮质类固醇吸入量。
   目的：我们旨在分析高海拔综合治疗的疗效，尤其是减少皮质类固醇方面。为了深刻了解影响减量的可能因素，我们分析了人口统计变数、开始治疗时的疾病控制和生活质量是否可预测皮质类固醇减量。
   方法：本前瞻性、非全相、队列研究分析了一个专门高海拔治疗中心中43例8～17岁儿童的数据。入院和出院时评估肺功能(FEV1, FEV1/VC)、炎症(FeNO)、医疗水平、哮喘控制(ACT)和生活质量(PAQLQ(S))。
   结果：32 (74%)名儿童达到了PSA标准。7(7%)名儿童每日口服类固醇激素。治疗72±30 (平均值±SD)天后，吸入性皮质类固醇（ICS）的平均剂量从1315ug±666布地奈德明显降至1132ug±514。所有患者都可以停止口服类固醇维持治疗。出院时FeNO，哮喘控制和生活质量比住院时有改善(p<0.001)；住院时和出院时的FEV1均在正常范围。除了开始时的ICS水平，多元回归分析显示没有相关因素可预测治疗时ICS剂量下降。
   结论：结果显示高海拔治疗可能是儿童PSA患者的治疗选择，但是治疗开始时的健康状态指标不能预测ICS逐渐减少。
 

（刘国梁 审校）
J Asthma. 2013 Dec 5. [Epub ahead of print]

Problematic severe asthma in children treated at high altitude: tapering the dose while improving control.

van de Griendt EJ, Verkleij M, Douwes JM, van Aalderen WM, Geenen R.

ABSTRACT
BACKGROUND: Multidisciplinary treatment at high altitude is a possible treatment option for problematic severe asthma (PSA) in children. This management can result in the tapering of inhaled corticosteroids.
AIM: Our aim was to analyze the effect of multidisciplinary treatment at high altitude, notably the ability to taper corticosteroids. To get an insight into possible factors influencing tapering, we examined whether demographic variables, disease control and quality of life at treatment entrance could predict the tapering of corticosteroids.
METHODS: This prospective open-phase cohort study analyzed the data of 43 children aged 8-17 years referred to a specialized high altitude treatment centre. Lung function (FEV1, FEV1/VC), inflammation (FeNO), medication level, asthma control (ACT), and quality of life (PAQLQ(S)) were evaluated on admission and at discharge.
RESULTS: Thirty-two (74%) children fulfilled PSA criteria. Three (7%) children used daily oral steroids. After 72±30 (mean±SD) days of treatment, the mean dosage of inhaled corticosteroids (ICS) could be significantly reduced from 1315ug±666 budesonide equivalent to 1132ug±514. Oral steroid maintenance therapy could be stopped in all patients. FeNO, asthma control and quality of life improved (p < 0.001) from admission to discharge; FEV1 was in the normal range on both occasions. Apart from ICS levels at entrance, multiple regression analyses did not show any associated factor predicting the reduction of ICS dosage during treatment.
CONCLUSION: The results indicate that high altitude treatment may be a treatment option for children with PSA, but it is not possible to predict ICS tapering off from health status variables at treatment entrance.
 

J Asthma. 2013 Dec 5. [Epub ahead of print]