The Investigation To The Lung Function And Therapeutic Effect On Bronchiolitis Children Treated With Inhalational Glucocorticoid

Objectives: To investigate the therapeutic effect of inhalational glucocorticoid Budesonide (Pulmicort) and fluticasone propionate (Flixotide) on pediatric bronchiolitis, and provide objective laboratory evidence for the clinical therapy of bronchiolitis, we measured the tidal lung function dynamics of pediatric bronchiolitis group, control group and normal group also the symptomatic relieve and prognosis in the acute stage. The measurement of tidal lung function is related to the airway obstruction and lung volume variation, thus reliable in evaluating the bronchiolitis and therapeutic effects.Methods: 100 pediatric patients consistent with the diagnostic standards of bronchiolitis of American Thoracic Society, in Department of Pediatrics, Hunan Provincial Hospital from Feb 1^st 2005 to April 30^th 2005 were randomly divided into two groups: the observe group and control group equally. Both groups adopt combined therapy after admission: the observe group treated with additional Pulmicort in hospital and utilize mist-container to inhalate Flixotide after discharge. The lung functions were determined before the therapy, post-therapy(discharge), 3 months post-therapy. Observe the symptomatic relieve of the acute stage, 3 months after discharge and one year physical follow-up. Take 30 health even-aged children as normal group. Main parameters: tidal volume(TV), Respiratory rate(RR), tidal expiratory flow 25%,50% and 75% (TEF,TEF25%,TEF50%,TEF75%),time ratio of peak-TEF in time of expiration (TPEF/TE), volume ratio of peak-TEF in volume of expiration (VPEF/VE), and peak tidal expiratory flow (PTEF).Meanwhile, taken velocity of flow as vertical coordinate, volume as abscissa coordination, a velocity-of-flow-to-volume curve(TFV curve) come up. Lower part of the curve take for inspiration, while upper one take for exspiration.Results:①. Duration of wheezing rales, moist rales, cough and hospitalization in inhalation group were significantly decurtated, P<0.05.②.no significant difference between the observe group and control one, P>0.05, but the frequence of cough and asthma outbreak in observe group is low than that of control one.③. pre-therapy(admission): parameters of lung function are no significant difference between observe group and control group, P>0.05, but two group to compare normal group is significant difference in TV, RR, VPEF/VE, TPEF/TE, TEF25%, P<0.05. post-therapy(discharge): VT, RR, TEF25% descended in inhalation group, as VPEF/VE and TPEF/TE ascend. The VT of control group post-therapy ascend with RF decreased, but no significant difference in TEF25%, VPTEF/VE and TPEF/TE. The amplitude of measuring indexes of inhalation group are more significantly increased than that of control one (P<0.05).④.After 3 months therapy, the TEF25%, VPEF/VE and TPEF/TE of inhalation group are all improved significantly than the control, even no significant differences to the normal group(P>0.05). Although VPEF/VE and TPEF/TE improved, the TEF25%,VPEF/VE and TPEF/TE of control group are different from those of normal group statistically(P<0.05).⑤. In the cases that could be followed up, 29 in 47 cases inhalation group restored, as 14 cases advanced into infant asthma. While in control group, only 13 cases restored 19 into asthma. The incidence of observe group is significantly lower than that of control group,P<0.05.⑥. The clinical evaluation score of bronchiolitis in acute stage characterized negative correlation to the TPEF/TE,VPEF/VE and TEF25%( the Spearman correlations are rTPEF/TE= - 0.745 , P<0.001; r VPEF/VE = - 0.719 , P <0.001; r TEF25% = - 0.557 , P <0.05),which means the score higher, the condition more severe and the TPEF/TE,VPEF/VE and TEF25% lower.Conclusions:①The dynamics parameters of tidal respiratory lung function of bronchiolitis are similar to those of bronchial asthma.②In bronchiolitis children, early intervention treatment with inhalational glucocorticoid is effective not only to the symptomatic relieves in the acute stage but also to debase the odds of advancing to bronchus asthma. ③Measurement of tidal respiratory lung function is highly valuable in evaluating the severity of bronchiolitis, surpervising the course and prognosis. TPEF/TE and VPEF/VE are correlation to the severity, thus could be important indexes to evaluate not only the bronchoilitis airway obstruction, degree of the disease, also the prognosis.