The Efficacy Of Two Different Treatment Strategies Observed In Children With Moderate Persistent Asthma

Objective We examined clinical efficacy of two treatment strategies including inhalingthe combination of corticosteroids and long-acting β2receptor agonists and inhaling thecorticosteroids while chewing leukotriene receptor antagonist in moderate persistentasthma children with increased or normal peripheral blood eosinophil. This study aimedto provide clinical evidence for choosing more effective treatment strategy earlier for thechildren with moderate persistent asthma.Methods139cases of children with moderate persistent asthma treated in the pediatricdepartment of the Affiliated Hospital of Hebei United University were choosed fromFebruary2012to September2013, all children with asthma are in line with the "ZhuFutang Practical Pediatrics"(Seventh Edition) diagnostic criteria for childhood asthma,the diagnosis of moderate persistent asthma are in line with the2008edition of "Childrendiagnosed with bronchial asthma prevention and treatment guidelines". The blood routineof children with moderate persistent asthma is tested before enrolled, according to theperipheral eosinophil is increased or not, the children were divided into two groupsnamely eosinophils increased group and eosinophil normal group. These two groups weredivided into two sub-groups by a randomized method, namely ICS+LABA therapysubgroup and ICS+LTRA therapy subgroup, the observation period is twelve weeks.Children in ICS+LABA subgroup and ICS+LTRA subgroup have no significantdifference in sex, age, course of disease, PEF%predicted and PEF variation rate, daytimeasthma score, nocturnal asthma score and other baseline data(P＞0.05). They arecomparable and informed consent. Children in ICS+LABA group inhale Seretide aerosol,q12h(each spray contains25micrograms of Salmeterol and125micrograms ofFluticasone propionate); Children in ICS+LTRA group inhale Flixotide aerosols(eachspray contains125micrograms of Fluticasone propionate), q12h, while chewingMontelukast5mg per night, and all patients were equipped with a Spacer to assist theinhalation. If the children have acute exacerbations of asthma during the observationperiod, fast-acting β2agonists should be given immediately. Withdrawal after symptomsdisappeared, and recorded the times of using the fast-acting reliever medication. At4,8,12weeks to follow-up all children regularly to check if the inhalation method is correctand collect the date. Using peak expiratory flow meter to test peak expiratory flow (PEF). After12weeks, all the data are collected including the daytime asthma score, thenocturnal asthma score, the PEF%predicted, the PEF variation rate, the frequency ofusing rescue medication, the days with few symptoms,the asthma control rate, theincidence of adverse reactions and other indicators.Results Both ICS+LABA therapy and ICS+LTRA therapy can significantly reducedaytime asthma score, nocturnal asthma score and improve lung function, the differencewas statistically significant(P＜0.05); ICS+LTRA therapy is better than ICS+LABAtherapy in children with peripheral eosinophil increased in reducing daytime asthmascore, PEF variation rate and the frequency of the using rescue medication, improving thePEF%predicted, the days with few symptoms, and the athma control rate is higher(P＜0.05); ICS+LABA therapy and ICS+LTRA therapy in children with peripheral eosinophilincreased have no statistically significant in the incidence of adverse reactions andnocturnal asthma score(P＞0.05). ICS+LABA therapy and ICS+LTRA therapy inchildren with peripheral eosinophil normal have no statistically significant in reducingdaytime asthma score, nocturnal asthma score, PEF variation rate and the frequency ofusing rescue medication, improving PEF%predicted, the days with few symptoms, theathma control rate and the incidence of adverse reactions(P＞0.05).Conclusion1ICS+LTRA treatment strategy might be a better choice in moderatepersistent asthma children with increased peripheral blood eosinophil;2Both ICS+LTRAand ICS+LABA treatment strategies are available and the treatment efficacies areequivalent in moderate persistent asthma children with normal peripheral bloodeosinophil.