医疗bis是什么WJP ｜低剂量布地奈德雾化吸入与孟鲁司特治疗儿童轻度持续性哮喘的疗效、支出与依从性比较-上海聚慕医疗器械有限公司

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前言

今天，小编为大家带来由浙江大学医学院附属儿童医院，南京医科大学附属儿童医院，首都医科大学附属北京儿童医院及上海交通大学附属第一人民医院多位专家发表在《世界儿科杂志（英文）》（WJP）的最新文章，探究孟鲁司特或布地奈德雾化吸入悬浮液作为单一治疗药物对中国儿童轻度哮喘的控制效果。

低剂量布地奈德雾化吸入与孟鲁司特治疗儿童轻度持续性哮喘的疗效、支出与依从性比较

Treatment of pediatric mild persistent asthma with low-dose budesonide inhalation suspension vs. montelukast in China

Cite: Zhi-Min Chen, De-Yu Zhao, Li Xiang L, Jian-Guo Hong. Treatment of pediatric mild persistent asthma with low-dose budesonide inhalation suspension vs. montelukast in China. World J Pediatr. 2021 Oct 6. doi: 10.1007/s12519-021-00464-7. Epub ahead of print. PMID: 34613593.

研究背景

目前的儿童哮喘防治指南推荐吸入糖皮质激素（ICS）为儿童哮喘控制治疗的优选药物，以往的meta分析显示，在良好设计的临床研究中，对于轻-中度儿童哮喘，使用ICS的控制效应优于孟鲁司特。但是在现实环境中，比较布地奈德雾化吸入悬浮液（BIS）与孟鲁司特的研究却有限，治疗依从性和持续性可能并不理想。这项研究旨在调查孟鲁司特或BIS作为单一治疗药物对中国儿童轻度哮喘的控制效果。

研究方法

研究数据来源于对患有轻度持续性哮喘的2-14岁儿童的多中心回顾性问卷分析，这些儿童使用500 ug BIS吸入（n=153）或依据年龄服用4 mg或5 mg 孟鲁司特（n=240），每天一次。评估哮喘控制状况、哮喘控制测试（ACT）/儿童ACT（C-ACT）评分以及与哮喘相关的医疗费用。

研究结果

在过去3个月，孟鲁司特组的用药依从性优于BIS组（P=0.042）。孟鲁司特组在过去4周内显示出更好的哮喘控制，包括每周出现症状超过两次（P=0.021）、夜间觉醒或夜间咳嗽（P=0.022）或每周使用缓解药物超过两次的哮喘儿童比例较低（P<0.001）。孟鲁司特组ACT/C-ACT评分≤19的儿童比例更低（P=0.015）。监护人报告，在过去12个月内接受孟鲁司特治疗的儿童与接受BIS治疗的儿童相比，运动耐受性显著提高（P<0.001）（表2）。

表 2 过去4周和12周哮喘控制评估结果比较

* 孟鲁司特组与低剂量BIS组疗效的chi-squared检验。

在过去12个月，BIS组与孟鲁司特组相比，哮喘相关的医疗费用显著增加（P<0.001）(图 1)。

图 1 过去12月哮喘相关医疗费用比较：A=平均哮喘相关医疗费用（元），P=0.001；B=医疗费用分别为<5000、5000-10000和≥10000的患者比例，P=0.002。

研究结论

低剂量布地奈德雾化吸入与口服孟鲁司特两种治疗方法对轻度持续性哮喘儿童的总体哮喘控制都是有效的。然而，在现实环境中，与孟鲁司特相比，使用BIS的患儿需要更多的缓解药物和更多可归因于哮喘的医疗支出。当然还应考虑依从性等因素对治疗效应的影响。

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Abstract

Backgroud: There are limited studies comparing budesonide inhalation suspension (BIS) with montelukast in real-world settings where treatment adherence and persistency may be suboptimal. This real-world study aims to investigate the control effectiveness of montelukast or BIS as a monotherapy in Chinese children with mild asthma.

Methods: Data were derived from a retrospective questionnaire-based analysis of 2‒14-year-old children with mild persistent asthma, who received either 500 μg of BIS (n = 153) or 4‒5 mg of montelukast (n = 240) once daily. The indicators of asthma control, the Asthma Control Test (ACT)/Childhood ACT (C-ACT) score, and the asthma-related medical costs were assessed. The differences between the two groups were compared using an unpaired t-test (normally distributed), Mann–Whitney U test (non-normally distributed) or chi-squared test (categorical variables).

Results: Medication compliance in the past 3-month period was better in the montelukast group than in the BIS group (P = 0.042). The montelukast group exhibited better asthma control in the past 4-week period, including lower percentages of asthmatic children with symptoms more than twice a week (P = 0.021), had night waking or night coughing (P = 0.022), or required reliever medication more than twice a week (P < 0.001). The montelukast group had a lower percentage of children with an ACT/C-ACT score ≤ 19 (P = 0.015). Caregivers reported a significantly better exercise tolerance in the children who received montelukast vs. BIS in the past 12 months (P < 0.001). Significantly higher medical expenditures attributable to asthma in the past 12 months were observed in the BIS group vs. montelukast group (P < 0.001).

Conclusions: Both treatments provided acceptable overall asthma control in children with mild persistent asthma; however, more reliever medication and more medical expenditures attributable to asthma were needed for BIS vs. montelukast in real-world settings, where factors such as compliance were also taken into account.