7~16岁支气管哮喘合并变应性鼻炎患儿的药物治疗分析

摘要

目的 分析支气管哮喘(哮喘)合并变应性鼻炎(AR)患儿的药物使用情况,评价AR的治疗对哮喘儿童及监护人生命质量的影响.方法 入选广州地区已诊断哮喘(持续期)合并AR 2~6月的7~16岁患儿262例,完成哮喘和AR病例调查表,登记哮喘的长期控制药物和鼻炎治疗药物,进行哮喘儿童主观生命质量评分(PAQLQ)和监护人生命质量评分(PACQLQ).结果 262例患儿中,哮喘长期控制药物中单独使用吸入糖皮质激素/长效β受体激动剂的联合吸入剂(ICS/LABA)、吸入糖皮质激素(ICS)和白三烯受体拮抗剂(LTRA)的患儿例数比率分别为59.1%(155/262)、8.0%(21/262)和5.7%(15/262),LTRA联合使用ICS/LABA或ICS共有16.8%(44/262),而10.3%(27/262)未予ICS或LTRA治疗.鼻炎药物使用鼻内激素(NICS)及NICS联用其他药物38.5%(101/262),使用LTRA或/和鼻用及口服抗组胺药或/和鼻用肥大细胞稳定剂共38.2%(100/262),而23.3%(61/262)未用鼻炎治疗药物.在使用ICS/LABA治疗的哮喘患儿中,鼻内激素治疗组的PAQLQ和PACQLQ均明显优于鼻炎未治疗组,t值分别为3.766和5.172,差异有统计学意义(P<0.01).结论 哮喘合并鼻炎儿童的哮喘长期控制药物多使用ICS/LABA的固定联合吸入剂,其次为LTRA和ICS.而共患的鼻炎存在治疗不足,23.3%未曾使用鼻炎治疗药物.治疗AR可明显改善哮喘患儿及监护人的生命质量评分.%Objective To analyze the medications for bronchial asthma and allergic rhinitis (AR) among chil-dren, and to evaluate the impacts of AR treatment on the quality of life among asthma children and their guardians. Methods Included in this study were a total of 262 children aged 7 to 16 years with confirmed diagnosis of persis-tent asthma and concomitant AR for 2 to 6 months. All subjects completed surveyed on information for asthma and AR, and were enquired about medications for long-term asthma control and AR treatment. For the survey, the chil-dren and their parents completed the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) and Pediatric Asthma Caregiver′s Quality of Life Questionnaire (PACQLQ), respectively. Results Of the 262 children, medications for long-term asthma control included single use of inhaled corticosteroid/long-acting beta receptor agonists (ICS/LABA) in 59.1% (155/262), inhaled corticosteroids (ICS) in 8.0% (21/262) and leukotriene receptor antagonists (LTRA) in 5.7% (15/262), respectively. Combined use of LTRA plus ICS/LABA or ICS was reported in 16.8% (44/262). 10.3%(27/262) of the children did not receive ICS or LTRA. Medications for AR included nasal inhaled corticosteroids (NICS) combined with other drugs in 38.5% (101/262), and LTRA and/or nasal/oral antihistamines and/or nasal mast cell stabilizers in 38.2% (100/262) of the children, while 23.3% (61/262) did not receive rhinitis medications. Among children who received ICS/LABA, additional medications for AR with NICS was associated with improved PAQLQ ( t=3.766) and PACQLQ (t=5.172) compared with those who did not receive AR treatment (both P<0.01), with statistical-ly significant difference. Conclusion Among children with asthma and AR, ICS/LABA inhalation is the most com-monly used regular treatment, followed by LTRA and ICS. However, treatment for concomitant AR in these children is inadequate, as reflected by the fact that 23.3%did not received rhinitis medications. Treatment of AR can significant-ly improve the quality of life among asthma children and their guardians.