间歇与每日吸入布地奈德对轻度持续性哮喘儿童肺功能及呼出气一氧化氮的影响

Effect of intermittent versus daily inhalation of budesonide on pulmonary function and fractional exhaled nitric oxide in children with mild persistent asthma

摘要:

目的 探讨间歇与每日吸入布地奈德对轻度持续性哮喘儿童的肺功能及呼出气一氧化氮（FeNO）的影响。方法 选择2016年1月至2018年1月就诊的6~14岁轻度持续性哮喘儿童共120例，采用分层随机法分为间歇吸入组60例（出现哮喘征兆时吸入布地奈德200?μg/d，持续6周）和每日吸入组60例（持续吸入布地奈德200?μg/d）。于治疗第3、6、9、12月进行随访，比较两组患儿基线资料、FeNO及肺功能指标的变化、激素用量、哮喘发作次数及哮喘病情控制情况。结果 两组患儿在治疗起始时，基线资料及FeNO、肺功能指标比较差异均无统计学意义（P > 0.05）。随着治疗时间的延长，两组患儿FeNO逐渐降低，肺功能指标逐渐改善（P < 0.001）。与间歇吸入组比较，每日吸入组在降低FeNO和提高1秒呼气量占预计值百分比（FEV1% pred）上具有优势（P < 0.001）。吸入方式和治疗时间对FeNO及肺功能指标的影响具有交互作用（P < 0.001），每日吸入组在治疗3个月后FeNO及肺功能指标迅速改善并趋于平稳，而间歇吸入组6个月后趋于平稳。治疗12个月后，两组患儿身高、体重增长及病情控制程度比较差异均无统计学意义（P > 0.05），间歇吸入组患儿布地奈德吸入量要明显少于每日吸入组（P < 0.05），但哮喘发作次数要多于每日吸入组（P < 0.05）。结论 间歇和每日吸入布地奈德对轻度持续性哮喘儿童能够达到相同的哮喘控制水平，且对患儿身高、体重增长均无影响；每日吸入布地奈德能够更加快速有效地降低FeNO和提高FEV1% pred；虽然间歇吸入能够减少激素用量，但有更高的哮喘发作风险。

Abstract:

Objective To study the effect of intermittent versus daily inhalation of budesonide on pulmonary function and fractional exhaled nitric oxide (FeNO) in children with mild persistent asthma. Methods A total of 120 children, aged 6-14 years, with mild persistent asthma who attended the hospital from January 2016 to January 2018 were enrolled. The children were divided into an intermittent inhalation group with 60 children (inhalation of budesonide 200?μg/day for 6 weeks when symptoms of asthma appeared) and a daily inhalation group with 60 children (continuous inhalation of budesonide 200 μg/day) by stratified randomization. The children were followed up at months 3, 6, 9, and 12 of treatment. The two groups were compared in terms of baseline data, changes in FeNO and pulmonary function parameters, amount of glucocorticoid used, number of asthma attacks, and asthma control. Results At the start of treatment, there were no significant differences in baseline data, FeNO, and pulmonary function between the two groups (P > 0.05). Over the time of treatment, FeNO gradually decreased and pulmonary function parameters were gradually improved in both groups (P < 0.001). Compared with the intermittent inhalation group, the daily inhalation group had a better effect in reducing FeNO and increasing the predicted percentage of forced expiratory volume in 1 second (FEV1%pred) (P < 0.001). The inhalation method and treatment time had an interaction effect on FeNO and pulmonary function parameters (P < 0.001). In the daily inhalation group, FeNO and lung function parameters were improved rapidly and stabilized after 3 months of treatment, while those in the intermittent inhalation group stabilized after 6 months. After 12 months of treatment, there were no significant differences in the increases in body height and body weight and the degree of disease control between the two groups (P > 0.05). Compared with the daily inhalation group, the intermittent inhalation group had a significantly lower amount of budesonide inhaled (P < 0.05) and a significantly higher number of asthma attacks (P < 0.05). Conclusions Intermittent inhalation and daily inhalation of budesonide can achieve the same level of asthma control in children with mild persistent asthma and both have no influence on the increases in body height and body weight. Daily inhalation of budesonide can produce a better efficiency in reduing FeNO and increasing FEV1%pred. Although intermittent inhalation can reduce the amount of glucocorticoid used, it may lead to a higher risk of asthma attacks.