ACAAI 2008:胃食道逆流治療緩解兒童氣喘


  November 11, 2008(西雅圖華盛頓)-根據一項發表在美國過敏氣喘與免疫醫學會2008年年會的研究報告,胃食道逆流疾病(GERD)治療可以改善罹患持續性氣喘兒童的肺功能。
  
  有某些證據指出,GERD可能誘發氣喘,但治療GERD是否可以改善兒童氣喘的問題,目前仍不清楚。
  
  主要研究者,來自路易斯安那州紐奧良杜蘭大學醫學院的Aaron Kobernick醫師向Medscape過敏與臨床免疫學表示,對於特定非過敏性的病患族群而言,GERD是治療考量的一個重要因子。
  
  總共有62位年齡介於6~11歲,罹患非異位性中度到持續性氣喘的病患被收納到這項研究中。使用食道酸鹼值測量,Kobernick博士與其同事確認出44位異常檢驗結果,且可能是罹患GERD的病患。總共有32位兒童被分派到GERD內科治療組(A組),另12位兒童被分派到GERD外科治療組(B組),而18位兒童繼續使用抗氣喘治療,且作為控制組(C組)。研究團隊使用肺功能量計來評估治療前與兩年後的肺功能。
  
  GERD治療對於每年每位病患的氣喘急性發作有顯著效應。接受治療病患(A組與B組)的急性發作次數是相當的(分別為0.61與0.78;P> .05)。C組的這些數據是顯著較低的(2.9;P<.05)。第一秒使力呼氣容積(FEV1)在A組有47%、B組有58%、C組為28%至少改善20%(C組與A組及B組的比較,P< .05)。
  
  治療兩年後,A組(內科治療組)中22%兒童使力呼氣氣流(FEF)25%-75%至少改善20%,B組(外科治療組)中25%兒童有相同程度的改善,而在C組為11%。A組與B組的FEF25%-75%顯著地比C組高(P< .05)。
  
  這項研究可能已經低估了有反應的病患數目,因為許多兒童在收納前接受過廣泛的檢驗與治療。Kobernick博士在他們的發表中表示,他們的肺部可能比納入研究前好得多。
  
  資深引言人,賓州荷夏賓州大學兒科與醫學教授Timothy Craig教授向Medscape過敏與臨床免疫學表示,這項研究讓我想到,如果你有一位皮膚檢測顯示沒有過敏的兒童患者,有很好的理由可以嘗試抗胃酸逆流藥物;他並沒有參與這項研究。
  
  這項研究並未接受商業贊助。Kobernick博士與Craig教授表示沒有相關資金上的往來。

ACAAI 2008: Gastroesophageal Reflux Disease Treatment Improves Asthma in Children

By Jim Kling
Medscape Medical News

November 11, 2008 (Seattle, Washington) — Treatment of gastroesophageal reflux disease (GERD) improves lung function in children with persistent asthma, according to a presentation here at the American College of Allergy, Asthma & Immunology 2008 Annual Meeting.

There is some evidence that GERD may provoke asthma, but it is not clear whether treating children with GERD improves asthma.

"In a select group of patients who are nonallergic, GERD is an important [factor] to consider in terms of therapy," lead investigator Aaron Kobernick, MD, MPH, from the Tulane University School of Medicine, in New Orleans, Louisiana, told Medscape Allergy & Clinical Immunology.

A total of 62 patients, aged 6 to 11 years, with nonatopic moderate to persistent asthma enrolled in the study. Using esophageal pH monitoring, Dr. Kobernick and colleagues identified 44 with abnormal results that suggested GERD. A total of 32 children were assigned to medical anti-GERD treatment (group A), 12 were assigned to surgical anti-GERD treatment (group B), and 18 continued regular anti-asthma treatment and acted as control subjects (group C). Researchers used spirometry to assess lung function before treatment and 2 years after treatment.

Anti-GERD treatment had a significant effect on the number of asthma exacerbations per patient per year. Patients who received treatment (groups A and B) had comparable numbers of exacerbations (0.61 and 0.78 respectively, P?> .05). Those numbers were significantly lower than in group C (2.9, P?< .05). An improvement in forced expiratory volume in the first second (FEV1) of at least a 20% was seen in 47% of children in group A, 58% of children in group B, and 28% of children in group C (P?< .05 for group C vs groups A and B).

After 2 years of treatment, 22% of children in group A (medical treatment) showed a greater than 20% improvement in forced expiratory flow (FEF)25%-75%, 25% of children in group B (surgical treatment) showed a similar improvement, as did 11% of children in group C. FEF25%-75% in groups A and B was significantly higher than in group C (P?< .05).

The study may have underestimated the number of patients who responded because many of the children had undergone extensive testing and treatment before enrollment. "Their lungs probably started looking a lot better before [they entered the study]," Dr. Kobernick said during his presentation.

The study "makes me think that if you have a child with a skin test that indicates no allergies, there's a good reason to try reflux medication," session moderator Timothy Craig, DO, professor of medicine and pediatrics at Penn State University, in Hershey, Pennsylvania, told Medscape Allergy & Clinical Immunology. He was not involved in the study.

The study did not receive commercial support. Dr. Kobernick and Dr. Craig have disclosed no relevant financial relationships.

American College of Allergy, Asthma & Immunology (ACAAI) 2008 Annual Meeting: Abstract 1. Presented November 9, 2008.

    
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