医学交流课件：Management of Preschool Wheeze.ppt

The IFWIN study: OUTCOMES Placebo Treatment (n=88) (n=85) Current wheeze 47% 52% MD Dx asthma 64% 61% Asthma Rx current 66% 66% Murray et al. Lancet 2006 Systemic Steroid treatment for wheezing disorders Systemic steroid for acute episode: Little benefits if any ICS the best treament for those recurrent wheezing (Asthma Prediction Index positive) Benefits in reducing symptoms Would not affect natural history The difficulties of treating wheezing illness in pre-school children Variable to no response Good response to Rx Good response to Rx Good response to Rx Acute wheezing Mild-severe, few 3 / yr 3 /yr episodes Symptoms /URI Short lasting, 7days symptoms often last 7 days 7 days Interval symptoms Little/none some interval interval symptoms Family Hx Atopy symptoms exercise Family history The challenges: Wheezing disorders in preschool children Different subtypes: phenotypes will change with time Intermittent ICS therapy: modest response in acute wheezing episodes Persistent type: positive asthma prediction index, better response and more likely to become persistent asthmatics Safe treatment: use ICS preparation with a favorable safety profile. Thank you * * * * * * Management of Preschool Wheeze Asher et al Lancet 2006;368(9537):733-43. Problems related to wheezing disorders in preschool children When do we call it asthma? What are the precipitates of attacks? What is the relationship with atopic asthma later on in life? What can be used to prevent attacks? Any drugs to alter the natural history? Preschool wheeze : What disease is it? Preschool wheezing is a very common symptom Up to 50% of Caucasian children have had at least one wheezing epidsode by age 6 yrs Prevalence is a bit lower for Asian children Wheeze is just a sympto