到编辑:
甘露醇挑战是一种间接挑战,增加了气道表面液体渗透压导致支气管机会[1那2]。Mannitol challenge tests are used clinically to diagnose asthma and, in particular, exercise-induced broncoconstriction (EIB) in adults and children above 6 years of age [3.]。T.o date, mannitol has not been used as a challenge agent in children under 6 years of age and the feasibility and safety of its use in this age group is unknown.
对幼儿支气管响应性的评估是难以受到儿童的合作的限制。适用于幼儿的肺功能试验的标准化,例如断路器技术或强制振荡技术(FOT),提供有助于评估幼儿支气管响应性的机会,并使用FOT的各种挑战测试在幼儿报道[4.]。
这aim of this preliminary study was to assess the feasibility and safety of the mannitol challenge test in young children using the FOT as the objective outcome measure.
招募了20岁的3-7岁儿童;这些儿童中的10个是健康的,10名儿童在过去一年中患有胃肠报告的运动诱导的症状(EIS)。甘露醇挑战测试(ARIDOL; Pharmaxis,法国森林,澳大利亚)如前所发表[2],例外情况下,呼吸阻力在8 Hz(R.RS8)从FOT被用作主要结果,并改变了阳性反应的定义,如下所述。
Prior to the mannitol challenge test the children were trained on the use of the mannitol dry powder inhaler using an inspiratory flow meter (In check; Clement Clarke International, Harlow, UK) configured to ensure that inhalation ranged between 30 and 50 L·min-1to optimise deposition of mannitol. An examination including chest auscultation, baseline heart rate (HR), arterial oxygen saturation measured by pulse oximetry (S.pO2) and lung function using FOT (I2M; Chess Medical; Ghent, Belgium) was performed in all children. During the mannitol inhalation challenge FOT was performed 1 min after each stage and 15 min after salbutamol inhalation at the end of the challenge. For baseline, control and post-salbutamol measurements, theR.RS8was an average of all acceptable FOT measurements at that stage; while the highestR.RS8在我们的小组先前使用的每种甘露醇吸入后[5.]。这S.pO2and HR were continually monitored throughout the test and the chest was auscultated within 1 min of each step of the mannitol inhalation.
A positive response to the challenge was recorded if there was one of the following: 1) an increase inR.RS8by 50% from the control inhalations; 2) persistent cough after mannitol inhalation; 3) wheeze on auscultation and 4) a drop inS.pO2to <90%. At the end of the challenge all children received 600 μg of salbutamol using a metered-dose inhaler through a large volume spacer regardless of response and all children were discharged whenR.RS8was within 20% of baseline.
这mannitol challenge was considered feasible if the child completed the test to the maximum dose of 635 mg, or until a positive response was noted. We considered the challenge safe if no serious adverse events were recorded,IE。致命或危及生命的事件,需要住院住院治疗的事件,导致持续或重大残疾的事件,或被视为医学上重要的事件或反应。
All 10 children with EIS and seven healthy children completed the challenge (table 1). Three healthy children did not complete the challenge and refused to continue at different stages; all were 3 years old. None of the 17 children that completed the test developed any serious adverse events, according to the study criteria, and all participants were discharged in a stable condition. Based on the response criteria listed on the Aridol (Pharmaxis) product approved label, one child would be classified as having a serious adverse event during the mannitol challenge with both wheeze and a decrease inS.pO2to 87% (subject 14). The family of this child also reported wheeze requiring reliever 2–4 h following discharge for which the parents administered salbutamol.
平均测试时间(范围)di的孩子d not respond to the mannitol challenge was 45 (37–54) min and longer than the test duration in children with a positive response (31 (13–38) min). Transient cough during mannitol inhalation was present in 95% of the children, with intermittent cough post-inhalation noted in 70% and 20% of the EIS and healthy groups, respectively. Six of the 10 children with EIS responded to the mannitol challenge, while none of the healthy children had a positive response (table 1).
在这个初步研究,我们报告一个吸气d mannitol challenge protocol, using FOT as an outcome, is feasible and safe in children aged 4–7 years, with 100% of children in this age group completing the test. The three children that failed to complete the test were 3 years-old and did not complete the test due to difficulty sustaining attention.
In this study there were no symptoms of serious respiratory distress noted during the challenge. One parent did report wheeze requiring reliever within 24 h following the challenge. Post-challenge asthma exacerbation within 24 h of a mannitol challenge has been reported in 0.2% of adults and older children [3.]。Further, larger studies are required to accurately define the safety profile of mannitol testing in this younger age group.
S.ix of the 10 children in the EIS group responded to the mannitol challenge and none of the healthy children responded. While this study was not designed to assess the ability of the mannitol challenge test to identify EIB in young children, these results provide initial evidence that mannitol challenge tests may be useful in this young age group. Three of the six children that responded to the mannitol challenge did so by an increase inR.RS8那suggesting that FOT can be used with mannitol challenge to facilitate the diagnosis of EIS in young children.
We used a 50% increase inR.RS8作为一个积极的反应。以前的研究使用具有吸入挑战测试的吸入挑战测试使用的截止级别从25%增加到50%R.卢比[5.-7.]。If a 25% increase inR.RS8is used to define a positive response the response rate in the EIS group would remain unchanged, with three of the healthy children being classified as having a positive response. Further studies to establish appropriate cut-off limits to be used for the mannitol challenge test with FOT as a primary outcome in young children are required.
在较旧的受试者中,与运动和高渗盐水挑战测试相比,甘露醇攻击试验对于EIB的诊断是高度特异性的[2那3.]。这项初步研究并没有尝试使用自由运行的运动挑战测试进行比较甘露醇挑战测试[7.[检查幼儿甘露醇测试的再现性,或探索缩短挑战测试的方法,并需要研究这种性质。
总之,这项初步研究报告说,在4-7岁时与FOT结合测量支气管响应性时,甘露醇攻击试验似乎是安全可行的。需要进一步研究探索甘露醇测试在幼儿中的作用。
Acknowledgments
作者愿承认Douglas(玛格丽特公主,玛格丽特医院,珀斯,珀斯,西澳大利亚大学,珀斯)为他们的宝贵意见,儿童和父母为他们的慷慨时间和努力以及G.BANTON(西澳大利亚大学Childen Health Charchiture Courture研究所,珀斯)技术援助。Pharmaxis Ltd(法国森林,澳大利亚)为曼尼尔提供了免费的研究。
Footnotes
Conflict of interest: Disclosures can be found alongside the online version of this article atwww.www.qdcxjkg.com.
- R.eceived2013年3月7日。
- 公认july 5, 2013.
- ©ERS 2013