5세 미만의 기침이형천식 소아에서 흡입용 스테로이드와류코트리엔 수용체 길항제의 치료 효과
Effect of Inhaled Corticosteroid and Leukotriene Receptor Antagonist in Cough-variant Asthma Patients under Five Years of Age
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목 적 : 기침이형천식을 앓고 있는 소아의 약 33-66% 정도가 수 년 뒤에 전형적인 천식으로 진행하는 것으로 보고되어져 있다. 본 연구에서는 5세 미만의 소아들 중 기침이형천식이 의심되는 환자들을 대상으로 흡입용 스테로이드와 류코트리엔 수용체 길항제를 사용하여 그 치료 효과를 비교하였다. 방 법 : 2002년 3월부터 2004년 8월까지 8주 이상의 만성기침을 주소로 동아대학교의료원 소아과를 방문한 5세 미만의 소아들 중 기침이형천식이 의심되는 37명을 대상으로 하였다. 이 중 13명은 흡입용 스테로이드(Pulmicort respule, 500 mg/회, bid)를 네뷸라이저를 통해 4주간 흡입하였으며(A군), 13명은 류코트리엔 수용체 길항제(Singulair, 4 mg)를 매일 취침 전에 한 번씩 4주간 복용하였으며(B군), 나머지 11명은 증상이 있을 때마다 속효성 기관지확장제(Ventolin solution, 0.2 mg/kg)만을 간헐적으로 흡입하였다(C군). 치료 효과는 치료 시작일과 치료 4주째에 각각 야간 기침과 수면 장애의 중등도를 증상 점수로 조사하여 비교하였다. 결 과: 1) 환자 나이, 혈청 총 IgE, 총 호산구수, 진단 전 기침 지속기간은 세 군간에 차이가 없었다. 또한, 과거력상 아토피피부염과 급성 모세기관지염을 앓았던 환자는 A군 5명, B군 5명이었으며, C군에는 한 명도 없었다. 2) 야간 기침의 중등도는 A군과 B군 모두 치료 전보다 치료 후에 의미있게 호전되었으며, (P<0.05) A과 B군은 C군에 비해 치료 후 증상 점수가 의미있게 호전되었다.(각각 P<0.01, P= 0.01) 3) 수면 장애의 중등도 역시 A군과 B군 모두 치료 전보다 치료 후에 의미있게 호전되었으나,(P<0.01) 세 군 사이의 증상 점수의 호전 정도에는 통계학적인 차이가 없었다.(P=1.00) 결 론:흡입용 스테로이드와 류코트리엔 수용체 길항제는 모두 기침이형천식 치료에 효과가 있었다.
Abstract
Purpose : Cough-variant asthma(CVA) is a common cause of chronic cough in young children. Some children who have CVA eventually develop classic asthma. We evaluated the effect of inhaled corticosteroid and leukotriene receptor antagonist in young children who are suspected of having CVA. Methods : Thirty-seven cough-variant asthma patients younger than 5-years-old were enrolled in this study. Fifteen were treated with pulmicort nebulization(500 µg, bid) for 4 weeks(Group A). Fourteen were treated with leukotriene receptor antagonist(Singulair, 4 mg) for 4 weeks(Group B). Eleven were treated with intermittent short-acting β2-agonist nebulization(Group C). We evaluated the mean change of symptom score in night cough and sleep disturbance. Results : There were no differences in age, sex, total IgE, total eosinophil count or duration of cough among the three groups. Group A and B showed significant improvement of night cough and sleep disturbance after treatment.(P<0.05) In Group A and B, night cough was significantly improved after treatment more than in control.(P<0.05) But improvements in sleep disturbance didn't have any signigicant differences between the three groups.(P= 1.0) Conclusion : Inhaled corticosteroid and leukotriene receptor antagonist are effective to control chronic cough in CVA children younger than 5-years-old.
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