Abstract Objective To study the incidence of acute attacks of asthma and dynamic changes in laboratory markers in children with well-controlled asthma after the withdrawal of low-dose inhaled corticosteroids (ICS), and to provide a basis for optimal long-term control regimens for children with asthma. Methods A total of 63 children with well-controlled asthma were enrolled as subjects. According to their parents' wishes, they were continuously administered with ICS (ICS treatment group; n=35) and without ICS (ICS withdrawal group; n=28). They were followed up for 18 months. The incidence of acute attacks of asthma was evaluated, dynamic monitoring was performed for pulmonary function and fractional exhaled nitric oxide (FeNO), and childhood asthma control test (C-ACT) was performed every three months. Results At 3, 6, 9, and 12 months of follow-up, there was no significant difference in FeNO between the ICS treatment and withdrawal groups (P > 0.05). However, at 15 and 18 months of follow-up, the withdrawal group had a significantly higher level of FeNO than the ICS treatment group (P < 0.05). There was no significant difference in the C-ACT score between the two groups at all time points of follow-up (P > 0.05). At 3, 6, 9, and 12 months of follow-up, there were no significant differences between the two groups in the percentage of forced expiratory volume in 1 second, the ratio of forced expiratory volume in 1 second to forced vital capacity, percentage of predicted maximum mid-expiratory flow (MMEF%), and maximal expiratory flow at 50% of vital capacity (MEF50) (P > 0.05), while at 15 and 18 months of follow-up, the ICS treatment group had significantly higher MMEF% and MEF50 than the withdrawal group (P < 0.05). During follow-up, 3 children (9%) in the ICS treatment group and 8 (29%) in the withdrawal group experienced acute attacks of asthma (P=0.0495). Conclusions Continuous inhalation of low-dose ICS can maintain the stability of pulmonary function and reduce acute attacks of asthma in children with well-controlled asthma.
ZHANG Min,WEN Zhi-Hong,YANG Cai-Qiong. A clinical follow-up study of children with well-controlled asthma after withdrawal of low-dose inhaled corticosteroids[J]. CJCP, 2019, 21(5): 421-425.
ZHANG Min,WEN Zhi-Hong,YANG Cai-Qiong. A clinical follow-up study of children with well-controlled asthma after withdrawal of low-dose inhaled corticosteroids[J]. CJCP, 2019, 21(5): 421-425.
Global Initiative for Asthma. Global strategy for asthma management and prevention[DB/OL]. (2018-03-06). https://ginasthma.org/wp-content/uploads/2018/04/wms-GINA-2018-report-V1.3-002.pdf.
Rank MA, Hagan JB, Park MA, et al. The risk of asthma exacerbation after stopping low-dose inhaled corticosteroids:a systematic review and meta-analysis of randomized controlled trials[J]. J Allergy Clin Immunol, 2013, 131(3):724-729.
[5]
American Thoracic Society; European Respiratory Society. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005[J]. Am J Respir Crit Care Med, 2005, 171(8):912-930.
[6]
Dweik RA, Boggs PB, Erzurum SC, et al. An official ATS clinical practice guideline:interpretation of exhaled nitric oxide levels (FENO) for clinical applications[J]. Am J Respir Crit Care Med, 2011, 184(5):602-615.
[7]
Rogers L, Reibman J. Stepping down asthma treatment:how and when[J]. Curr Opin Pulm Med, 2012, 18(1):70-75.
[8]
van Essen-Zandvliet EE, Hughes MD, Waalkens HJ, et al. Remission of childhood asthma after long-term treatment with an inhaled corticosteroid (budesonide):can it be achieved? Dutch CNSLD Study Group[J]. Eur Respir J, 1994, 7(1):63-68.
[9]
Zheng S, Yu Q, Zeng X, et al. The influence of inhaled corticosteroid discontinuation in children with well-controlled asthma[J]. Medicine, 2017, 96(35):e7848.
[10]
Rank MA, Johnson R, Branda M, et al. Long-term outcomes after stepping down asthma controller medications[J]. Chest, 2015, 148(3):630-639.
Martinez FD, Chinchilli VM, Morgan WJ, et al. Use of beclomethasone dipropionate as rescue treatment for children with mild persistent asthma (TREXA):a randomised, double-blind, placebo-controlled trial[J]. Lancet, 2011, 377(9766):650-657.
[14]
Burgess JA, Matheson MC, Gurrin LC, et al. Factors influencing asthma remission:a longitudinal study from childhood to middle age[J]. Thorax, 2011, 66(6):508-513.
Petsky HL, Kew KM, Chang AB. Exhaled nitric oxide levels to guide treatment for children with asthma[J]. Cochrane Database Syst Rev, 2016, 11:CD011439.
Pijnenburg MW, Bakker EM, Lever S, et al. High fractional concentration of nitric oxide in exhaled air despite steroid treatment in asthmatic children[J]. Clin Exp Allergy, 2005, 35(7):920-925.
