The Effect Of Different Glucocorticosteroid Inhalating Regimens In Children With Asthma

Objective: To investigate the effect of different glucocorticosteroid inhalating regimens in children with asthmaMethods: (1)323patients with moderate asthma were enrolled in a 12-weekrandomized parallel-group remissive treatment after a 4-week baseline treatment. During the baseline treatment terbutaline sulfate 250μg tid and budesonide 200μg bid were given, and oral bronchodilators were allowed if necessary. The remissive treatments were comprised of budesonide inhalation 100μg once a day (QD), 100μg twice a day (BID) and 200μg QD. Patients subsuqiently returned to the clinic for 3 additional clinic visits (week 4, 8 and 12) or telephone visits. At every clinic visit,the daytime and nighttime severity score were recorded and spirometry was conducted in patients who was capable of performing the maneuver; (2)112 children with moderatr or serious infant asthma were divided into two groups randomly. The budesonide inhalation suspension group 48 cases (nebulising group) were given budesonide inhalation suspension through jet nebulizer; pulmicort aerosol group 64 cases (aerosol group) were given pulmicort aerosol through meterd dose inhalers (MID) + spacer inhaler. The inhalation dosage of glucocorticosteroid decreased greadly according to the day-time and night-time clinical symptom score .The day-time and night-time clinical symptom score,compliance,attack times and inhalation dosage of glucocorticosteroid during remissive period were inversitiated at every clinical visit or by telephone. All patients were followed up for 48 weeks.the nebulising group were measure the levels of 24h urine free cortisol(24h-UFC) before treatment and after treatment 3,48 weeks,and established the normal children to check against at the same time.Results: (1) Ultimately, 323 children were enrolled in the baseline treatment. And 281 (87%) children achieved clinical remission. The rate of compliance decreased gradually during the remissive treatment,but compared with 200μgQD , the 100μgBID (u=2.128; p<0.05) and 100μg QD(u=2.304; p<0.05) regiments were greatly decreased at the end of 12 week remissive treatment .The remissive rate of 100μg BID and 200μg QD regiments who have finished the 12-week remissive treatment is greatly higher than that of 100μg QD (u=2.01, 1.97; p<0.05) .The total remissive rate of 200μgQD is markedly higher than that of 100μgQD(u=4.375,p<0.01) and 100μg BID (u=4.109,p<0.01) . (2) Compared with aerosol group ,the clinical symptom score,inhalation dosage of glucocorticosteroid during remissive period and attack times were lower significantly in nebulising group (t=2.20～8.29,P<0.05～0.01) . The compliance was significantly higher than that in aerosol group(t=2.46,p<0.05).compared with the normal children ,the 24h-UFC was similar in nebulising group after treatment 3,48 weeks.Conclusion: The authors concludes that budesonide by turbohaler 400μg/d for baseline treatment and 200μg/d for remissive treatment may achieve ideal clinical effects to Chinese children with moderate asthma, and it is as effective once-daily as twice-daily with the same total daily dose during remissive treatment budesonide inhalation suspension step nebulising inhalation therapy in infant asthma are high clinical control, high compliance , convenient and safe,has no singnificient influence in costisol, so it deserves to be performed in more patients.