| Bronchial asthma(hereinafter the asthma) is one of common chronic disease of respiratory tract in childhood, many investigation showed that the morbidity of asthma is increasing in past 20 years. The pathogenesis of asthma is very complex. It is considered that the chronic inflammation of airway is the essence of asthma at present, witch increased the vicious cycle of airway spasm--- airway hyper reactivity---exposes in irritant. Airway hyper reactivity is a highly sensitive state of variety of incentives with airway such as allergens, physical factors, chemical factors, sports and so on, which is a basic characteristics of asthma. It can show the severity of airway chronic inflammation in some extent. The characteristics of clinical manifestation of asthma is intermittent attacks. Performance for repeated attacks of wheezing, coughing, chest tightness, shortness of breath and so on, which usually appears during the night and strenuous exercise. These symptoms are closely related to a wide variety of reversible airflow obstruction, can be effective treatment or self remission. But if the asthma is not treated effective, It will be prone to repeated attacks and progressive exacerbation, in severe cases, the patient will appear in the critical state of asthma. Usually expressed as difficulty in breathing, sweating, restlessness, even orthopnea, disturbance of consciousness and respiratory and circulatory failure and threaten to the children’s safety. Therefore, repeated attacks of asthma seriously affect the physical and mental development of children. At present, with the progress of inflammation theory and asthma, glucocorticoid(GC) has been used as the first-line drugs for the treatment of asthma. Systemic application of GC has produced obvious systemic adverse reactions, while, inhaled corticosteroid(ICS) has been widely used because of its good curative effect, direct effect on airway mucosa and few side effects. But at the same time, ICS in the long course of treatment, suction type, dose and frequency of different, in the pediatricians and parents widely exists security dispute. Budesonide(BUD) is the most commonly used a kind of ICS, it can effectively eliminate airway inflammation and decrease airway hyper responsiveness, and achieve the purpose for the treatment of asthma. Long-term inhalation of BUD would impact on asthma children of bone metabolism and bone mineral density(BMD), is the focus of pediatricians and families of children with attention. This study was to observe the effect of BUD on bone metabolism and bone mineral density in 60 children with asthma, and to understand the safety of long-term inhaled ICS in the treatment of asthma.Objective:By detecting the change of bone metabolic biochemical indexes of blood calcium(Ca), blood phosphorus(P), blood alkaline phosphatase(ALP) and bone mineral density after the children with asthma who inhaled budesonide for a long time, exploring the influence of bone metabolism and bone mineral density index and knowing if it is possible to cause bone mass loss after long-term inhaled BUD, then guide the treatment of children with asthma of aerosol inhaled GC to prevent and control the asthma attacks.Methods:Collecting 60 cases of children with bronchial asthma which are treated in our hospital outpatients and inpatients from January 2014 to October 2015. The selected children all regularly nebulized BUD 3 months or more. Investigation the three common factors: dietary factor, physical activity and sunshine time, which affect metabolism and mineral density of bone during the medication, in order to understand the balance distribution of these factor. For the selected children were measured the calcium, phosphorus alkaline phosphatase in blood and BMD during these three time windows---one month before medication, during the medication, 3 month for medication. All data can be inputted Excel. Then analysis the data by using SPSS 19.0 statistical software. First is description of the frequency distribution of general data. Then inspect the difference of index mean χ2 test and analysis of variance.Result:1 General situation analysis with children with asthma: The average age of the children are 2.17±0.67 years old, and between the age of 1 to 2 is 45%(27), between the age of 2 to 3 is 55%(33). Male and female each accounted for 56.7%(34) and 56.7%(26). Analyzing the three factors which affect bone metabolism index and bone mineral density in the process of treatment with selected children. Dietary factor: rational diet and no dietary bias is good, 80%-85%(48-50). Physical activity: activity time is greater than 2 hour is good, 86%-89%(52-53). Sunshine time: greater than 2 hour for the better, 86%-89%(52-53), there was no statistical significance to compare the difference between the three periods.2 The changes of bone metabolism index on three points: The measured results of blood calcium, blood phosphorus and blood alkaline phosphatase before the children take the medicines, have taken the medicines for a month and for 3 month. The results are blood calcium(mmol/L) 2.26±0.16, 2.28±0.15, 2.27±0.13(P=0.64); blood phosphorus(mmol/L) 1.78±0.18, 1.80±0.19, 1.82±0.16(P=0.52); ALP(U/L) 116.80±20.42, 115.15±17.07, 115.53±17.04(P=0.87). The comparion of all the index mean are P > 0.05, and the difference have no statistical significance.3 The changes of bone mineral density on three points: The measured results of BMD(Z-score) before the asthma children take the medicines, have taken the medicines for a month and for 3 month are 0.45±0.28, 0.51±0.30, 0.50±0.27(P=0.55). The comparion of the index mean is P > 0.05, and the difference has no statistical significance.Conclusions:1 The selected asthmatic children’s dietary factor, physical activity and sunshine time are balanced during the time they nebulized budesonide.2 The selected asthmatic children’s bone metabolism index and bone mineral density have no significant changes after they long-term nebulized budesonide. Long-term inhaled budesonide won’t affect the bone growth of children with asthma. |
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