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12岁以下儿童的哮喘：使用控制药物治疗持续哮喘

Authors
Gregory Sawicki, MD, MPH
Kenan Haver, MD
Section Editors
Robert A Wood, MD
Gregory Redding, MD
Deputy Editor
Elizabeth TePas, MD, MS
Translators
黄莉, 副主任医师

引言

长期使用控制药物治疗12岁以下儿童的持续哮喘将总结在此。下文的推荐基于2007年出版的美国国家哮喘教育和预防计划(National Asthma Education and Prevention Program, NAEPP)的专家小组指南[1]，该指南与其他已发表的主要哮喘指南相似[2,3]。评估初始哮喘严重程度、确定何时开始每日控制性治疗，以及评估并监测哮喘控制情况以明确是否需要调整治疗，这些内容将单独详细讨论。 (参见“12岁以下儿童哮喘的初始治疗和监测控制”)

儿童哮喘的初始评估和诊断、对于儿童急救药物的使用及儿童哮喘急性发作的治疗，均将单独讨论。哮喘治疗和诱因控制的一般概述参见其他专题，青少年与成人哮喘的治疗也参见其他专题。 (参见“12岁以下儿童的哮喘：初始评估和诊断”和“12岁以下儿童哮喘：急性症状的急救治疗”和“儿童哮喘急性发作的急诊科治疗”和“儿童哮喘急性发作：住院患者处理”和“哮喘管理概述”和“控制诱发因素以加强哮喘管理”和“青少年和成人间歇性哮喘及轻度持续性哮喘的治疗”和“青少年和成人中度持续性哮喘的治疗”)

我们的方案

我们对12岁以下儿童持续哮喘的每日控制药物治疗方案，与NAEPP专家小组对0-4岁和5-11岁儿童的慢性哮喘的治疗指南是一致的(图 1和表 1和表 2和图 2和表 3和表 4)[1]。NAEPP专家小组对青少年和成人哮喘治疗的推荐，参见其他专题。 (参见“青少年和成人间歇性哮喘及轻度持续性哮喘的治疗”和“青少年和成人中度持续性哮喘的治疗”)

治疗12岁以下儿童哮喘的控制药物包括：吸入型糖皮质激素[也称为吸入型皮质类固醇(inhaled corticosteroid, ICS)](表 5)、口服白三烯受体拮抗剂(leukotriene receptor antagonist, LTRA)、吸入型长效β受体激动剂(long-acting beta agonist, LABA)联合吸入型糖皮质激素、口服糖皮质激素、吸入型色酮类和口服缓释茶碱(表 6)。在下文关于各类药物的章节，将总结我们推荐的治疗方案的证据。

开始控制性治疗 — 我们建议，对于有轻度持续哮喘儿童，采用每日给予低剂量吸入型糖皮质激素作为一线控制性治疗(第2级治疗)(图 1和表 1和图 2和表 3和表 5)[1,4,5]。我们建议，对于0-4岁中度至重度持续哮喘儿童，采用每日给予中剂量吸入型糖皮质激素作为一线控制性治疗(第3级治疗)。对于5-11岁中度至重度持续哮喘的儿童，我们建议每日给予中剂量吸入型糖皮质激素(第3级治疗)，或中剂量吸入型糖皮质激素加一种LABA或一种LTRA(第4级治疗)。儿童及其照料者应接受关于合理使用医生开具的(一种或多种)给药装置的指导，以确保儿童获得(一种或多种)药物的全部益处。开始控制性治疗的指征，将单独作更详细的讨论。 (参见下文‘吸入型糖皮质激素’和“儿童药物雾化器的使用”和“The use of inhaler devices in children”和“12岁以下儿童哮喘的初始治疗和监测控制”)

                               

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