| Objective:To investigate the relapse of children with asthma after regular application of inhaled corticosteroids(ICS)and drug discontinuance as well as to analyze relevant factors of asthma,in order to effectively take corresponding measures to reduce the relapse rate of asthma.Method:104 children,which were treated regularly with ICS(in accordance with diagnosis and treatment guidelines of childhood asthma in China)and had stopped ICS administration,were selected from more than 2000 children with age of 4-14 years suffering from asthma at the department of pediatrics in the second affiliated hospital of Tianjin Medical University from January 2014 to December 2015,in which 70 were boys and 34 were girls.By tracing back to the first onset of asthma all the way to carrying out follow-up observations 1 year and longer after discontinuance of asthma inhibiting drug,by means of questionnaires,investigate the causes of relapse after drug discontinuance and analyze relevant risky factors of asthma.Results:1.There were 64 out of 104 children suffering from asthma relapse after discontinuance of ICS,thereby relapse rate were 61.54%.Among the 64 children suffering from relapse,there were 43 boys and 21 girls;difference of relapse rates between different genders was not statistically significant;Recurrence rate of children having mold allergy was higher than that of children not having mold allergy;Recurrence rate of breast-fed children was lower than that of children who were mixed fed or artificial fed;Recurrence rate of children having the family history was slightly higher than that of children not having the family history;Recurrence rate of children who were premature at their birth was significantly higher than that of children who were full-term at their birth;Recurrence rate of children who were delivered by caesarean section was higher than that of vaginally delivered children;Recurrence rates of overweight and underweight children were both significantly higher than that of normal-weight children;Children suffering from nasosinusitis complicated with asthma had relapse rate higher than that of children without nasosinusitis;Recurrence rate of children who were treated with ICS combined with LABA was lower than that of children who were treated with ICS alone,but all the differences was not statistically significant(P>0.05).2.Relapse rate of children having first asthma onset under 6 years old was higher than that of children having first asthma onset at age of 6 years or more,the difference was statistically significant(P<0.05).3.Relapse rate of asthma in children,to which course of ICS treatment were applicated for 6-11 months,12-24 months,25-36 months and more than 36 months,was 91.67%,62.26%,62.50% and 33.33% respectively.Children with course of treatment lasting less than 12 months had relapse rate obviously higher than that of the other children,difference was statistically significant(P<0.05);while children with course of treatment lasting more than 36 months had relapse rate obviously lower than that of the other children,difference was statistically significant(P<0.05).4.Relapse rate of children with stable phase before drug discontinuance(clinical remission period of asthma)lasting less than 4 months,4-7 months,8-11 months and12 months and more was 90.91%,72.22%,72.73% and 51.56% respectively.Children with stable phase lasting less than 4 months had relapse rate higher compared to the other children,although difference was not statistically significant(P=0.074);Children with stable phase lasting 12 months and more had relapse rate lower than that of the other children,and difference was statistically significant(P < 0.05);difference was not statistically significant between children with stable phase lasting4-7 months and 8-11 months(P>0.05).5.Children suffering from moderate asthma had relapse rate obviously higher than that of children suffering from mild asthma,but difference was not statistically significant between them(P>0.05);and children suffering from severe asthma had relapse rate obviously higher than that of children suffering from moderate asthma,and difference was statistically significant(P<0.05).6.Children suffering from allergic rhinitis complicated with asthma had relapse rate higher than that of children without allergic rhinitis,and difference was statistically significant(P<0.05).7.Recurrence rate of children who stopped taking asthma medication in winter was higher than that of children who stopped taking asthma medication in three other seasons;however,the difference was statistically significant only when compared with children who stopped taking asthma medication in summer(P<0.05).8.Recurrence rate of children having mite allergy was higher than that of children not having mite allergy,but the difference was not statistically significant(P > 0.05).Among children having mite allergy,recurrence rate of children who received Allergen specific immunotherapy(AIT)treatment was significantly reduced when compared with children lacking AIT treatment,and the difference was statistically significant(P<0.05).9.Recurrence rate of children at higher Fe NO levels was significantly higher than that of children at lower Fe NO levels,and the difference was statistically significant(P<0.05).10.Decline of lung function was found in 2 children at return visit,and after immediately treating with ICS again,no recurrence of asthma occurred subsequent to drug discontinuance.11.The trigger factors of recurrence included upper respiratory infection,exercise,allergen exposure,laughter,haze,weather change as well as study pressure.The main trigger factors were upper respiratory infection andallergen exposure.Conclusion:1.Recurrence of asthma in children after stopping ICS are closely related with age of onset,course of ICS treatment,severity of disease,stable period before drug discontinuance,coexisting diseases such as allergic rhinitis,season of drug discontinuance,whether or not receiving anti-mite treatment,higher Fe NO levels upon drug discontinuance;2.The main trigger factors of recurrence were upper respiratory infection and allergen exposure. |
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