Use of sputum eosinophil counts to guide management in children with severe asthma
Use of sputum eosinophil counts to guide management in children with severe asthma
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DOI：
10.1136/thx.2010.156836
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发表时间：
2012-03-01
期刊：
影响因子：
10
通讯作者：
Bush, Andrew
中科院分区：
文献类型：
--
作者：
Fleming, Louise;Wilson, Nicola;Bush, Andrew
背景先前在成人哮喘患者中进行的研究将控制痰嗜酸粒细胞纳入管理策略中，结果表明哮喘患者的病情恶化程度显著降低。方法55名7-17岁的重症哮喘儿童被随机分成两组，一组采用传统的症状治疗策略，另一组采用基于炎症的治疗策略(主要是痰嗜酸粒细胞)。结果与症状管理组比较，炎症治疗组总急性加重和严重急性加重的年发生率(3.6vs4.8，发生率比0.75，95%CI0.54~1.04，p=0.082；1.9vs2.7IRR0.73，95%CI0.42~1.28，p=0.274)无显著差异。炎症处理组在研究访问后28天内经历恶化的受试者明显较少。哮喘控制措施(无症状天数和短效β-受体激动剂的使用)对炎症治疗组有利，但差异不大。在整个研究过程中，吸入皮质类固醇的剂量没有显著差异。结论将控制痰中嗜酸粒细胞纳入管理算法中，并不能显著减少总体恶化或改善哮喘控制。短期内病情恶化的情况有所减少，这表明需要更频繁的测量才能达到临床上的有用效果，而且控制炎症可能在严重哮喘儿童的亚组中发挥作用。
Background Previous studies in adults with asthma incorporating the control of sputum eosinophils into management strategies have shown significant reductions in exacerbations. A study was undertaken to investigate whether this strategy would be successful in children with severe asthma.Methods 55 children (7-17 years) with severe asthma were randomised to either a conventional symptom-based management strategy or to an inflammation-based strategy (principally sputum eosinophils). Children were seen 3-monthly over a 1-year period.Results The annual rate of total and major exacerbations (courses of oral corticosteroids) was non-significantly lower in the inflammatory management group compared with the symptom management group (3.6 vs 4.8, incident rate ratio (IRR) 0.75, 95% CI 0.54 to 1.04, p=0.082; and 1.9 vs 2.7 IRR 0.73, 95% CI 0.42 to 1.28, p=0.274 for total and major exacerbations, respectively). Significantly fewer subjects in the inflammatory management group experienced an exacerbation within 28 days of a study visit. There were small non-significant differences in measures of asthma control (symptom-free days and short-acting beta agonist use) favouring the inflammatory management group. There was no significant difference in the inhaled corticosteroid dose prescribed over the course of the study.Conclusion Incorporating the control of sputum eosinophils into the management algorithm did not significantly reduce overall exacerbations or improve asthma control. Exacerbations were reduced in the short term, suggesting that more frequent measurements would be needed for a clinically useful effect and that controlling inflammation may have a role to play in subgroups of children with severe asthma.