Abstract Objective To study the application value of asthma predictive index (API)-based group therapy in wheezing children under 5 years of age. Methods A total of 239 wheezing children under 5 years of age were divided into API-positive (n=126) and API-negative groups (n=113). Each group was randomly assigned to inhaled corticosteroids (ICS) subgroup and montelukast sodium (leukotriene receptor antagonist, LTRA) subgroup. The ICS and LTRA subgroups received the same drug therapy at the same dosage within the first four weeks of treatment. In the stable period of disease, the ICS subgroup only received aerosol inhalation of budesonide suspension, while the LTRA group was orally given montelukast sodium only. Asthma symptom scores were assessed and recorded at different time points. Results In the first four weeks of treatment, ICS and LTRA were effective both in the API-positive and API-negative groups; the two groups showed significant improvements in asthma symptom scores, and the asthma symptom score showed no significant difference between the ICS and LTRA subgroups of each group. After 24 weeks of treatment, the two therapies were still effective; in the API-positive group, the LTRA subgroup had a better treatment outcome than the ICS subgroup, but there was no significant difference in treatment outcome between the LTRA and ICS subgroups of the API-negative group. Conclusions For wheezing children under 5 years of age, therapeutic strategies can be chosen based on API in the stable period of disease, so as to better control wheezing.
LI Ya-Qin,XUE Hai-Yan,CHEN Wei et al. Application of asthma predictive index-based group therapy in wheezing children under 5 years of age[J]. CJCP, 2014, 16(8): 795-799.
LI Ya-Qin,XUE Hai-Yan,CHEN Wei et al. Application of asthma predictive index-based group therapy in wheezing children under 5 years of age[J]. CJCP, 2014, 16(8): 795-799.
Brand PL, Baraldi E, Bisgaard H, et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach[J]. Eur Respir J, 2008, 32(4): 1096- 1110.
Camargo CA Jr. Human rhinovirus, wheezing illness, and the primary prevention of children asthma[J]. Am J Respir Crit Care Med, 2013, 188(11): 1281-1282.
[4]
Castro-Rodriguez JA. The Asthma Predictive Index: A very useful tool for predicting asthma in young children[J]. J AllergyClin Immunol, 2010, 126(2): 212-216.
[5]
Guilbert TW. Identifying and managing the infant and toddler at risk for Asthma[J]. J Allergy Clin Immunol, 2010, 126(2): 417- 422.
Castro-Rodriguez JA, Holberg CJ, Wright AL, et al. A clinical index to define risk of asthma in young children with recurrent wheezing[J]. Am J Respir Crit Care Med, 2000, 162(4 Pt 1): 1403-1406.
[9]
Hirota T, Harada M, Sakashita M, et al. Genetic polymorphism regulating ORM1-like3 ( Saccharomyces cerevisiae) expression is associated with childhood atopic asthma in a Japanese population[J]. J Allergy Clin Immunol, 2008, 121(3): 769-770.
[10]
Galanter J, Choudhry S, Eng C, et al. ORMDL3 gene is associated with asthma in three ethnically diverse populations[J]. Am J Respir Crit Care Med, 2008, 177(11): 1194-1200.
[11]
Wu H, Romieu I, Sienra-Monge JJ, et al. Genetic variation in ORM1-like 3 (ORMDL3) and gasdermin-like (GSDML) and childhood asthma[J]. Allergy, 2009, 64(4): 629-635.
[12]
Pinto LA, Stein RT, Kabesch M. Impact of genetics in childhood asthma[J]. J Pediatr( Rio J), 2008, 84(4): S68-S75.
[13]
Lee YH, Song GG. Association between ADAM33 T1 polymorphism and susceptibility to asthma in Asians[J]. Inflamm Res, 2012, 61(12): 1355-1362.
Papi A, Nicolini G, Boner AL, et al. Short term efficacy of nebulized beclomethasone in mild-to-moderate wheezing episodes in preschool children[J]. Ital J Pediatr, 2011, 37: 39.
[16]
Zeiger RS, Mauger D, Bacharier LB, et al. Daily or intermittent budesonide in preschool children with recurrent wheezing[J]. N Engl J Med, 2011, 365(21): 1990-2001.
[17]
Baraldi E, Rossi GA, Boner AL. Budesonide in preschoolage children with recurrent wheezing[J]. N Engl J Med, 2012, 366(6): 570-571.
[18]
Guilbert TW, Morgan WJ, Zeiger RS, et al. Long-term inhaled corticosteroids in preschool children at high risk for asthma[J]. N Engl J Med, 2006, 354(19): 1985-1997.
[19]
Murray CS, Woodcock A, Langley SJ, et al. Secondary prevention of asthma by the use of inhaled fluticasone propionate in wheezy infants (IFWIN): double-blind, randomised, controlled study[J]. Lancet, 2006, 368(9537): 754- 762.
[20]
GINA Report, Global Strategy for Asthma Management and Prevention[EB/OL]. [February 9, 2012]. http://www. ginasthma. com.
[21]
British Thoracic Society, Scottish Intercollegiate Guidelines Network. British Guideline on the management of asthma[EB/OL]. [February 9, 2012]. http://www.brit-thoracic.org.uk.
[22]
National Heart, Lung, and Blood Institute National Asthma Education and Prevention Program. Expert Panel Report 3. Guidelines for the Diagnosis and Management of Asthma[EB/OL]. [February 9, 2012]. http://www. nhlbi. nih. gov.
[23]
Robertson CF, Price D, Henry R, et al. Short-course montelukast for intermittent asthma in children: a randomised controlled trial[J]. Am J Respir Crit Care Med, 2007, 175(4): 323-329.
[24]
Bisgaard H, Zielen S, Garcia-Garcia ML, et al. Montelukast reduces asthma exacerbations in 2- to 5-yearold children with intermittent asthma[J]. Am J Respir Crit Care Med, 2005, 171(4): 315-322.
[25]
Bacharier LB, Phillips BR, Zeiger RS, et al. Episodic use of an inhaled corticosteroid or leukotriene receptor antagonist in preschool children with moderate to severe intermittent wheezing[J]. J Allergy Clin Immunol, 2008, 122(6): 1127-1135.
[26]
Johnston NW, Mandhane PJ, Dai J, et al. Attenuation of the September epidemic of asthma exacerbations in children: a randomized, controlled trial of montelukast added to usual therapy[J]. Pediatrics, 2007, 120(3): e702-e712.
