哮喘的特征是气道的高反应性,运动诱发的支气管痉挛(EIB)是一种限制大部分哮喘患者的症状,尤其是儿童。持续气道正压(CPAP)导致气道反应性降低。这项研究的目的是评估CPAP和双水平压力联合呼吸物理治疗对运动支气管激发试验引起的支气管高反应性哮喘儿童和青少年的影响。
随机,控制,盲,临床试验涉及68名4至16岁的哮喘儿童和青少年,分为三组:G1,双水平压治疗(吸气气道正压:12cmH2O;呼气气道正压:8cmH2O),G2,用CPAP(8cmH2O)和G3治疗,用呼吸肌训练(RMT)治疗,作为对照组。所有组均在门诊诊所接受治疗,并接受10个1小时的治疗,每个还包括呼吸锻炼。在治疗前后进行评估,并涉及肺活量测定,运动支气管激发试验,呼吸压力,一氧化氮(FeNO),哮喘控制问卷(ACQ6)和人体测量变量。本研究获得当地伦理委员会的批准(证书编号:1487225/2016),并在ClinicalTrials[ClinicalTrials.gov标识符:NCT02939625]注册。
共有64名患者完成了该方案;患者的平均年龄为10岁。所有人都在理想的体重范围内并且具有足够的身高(z评分:-2至+2)。三组治疗后哮喘控制得到改善,从部分控制到完全控制。三组患者的最大吸气压力显著升高,RMT组增幅最大。在双水平组中,FeNO的减少约为十亿分之17.4(效应大小:2.43),并且在运动支气管激发试验中支气管反应性降低。在CPAP组中,FeNO的改善程度为每十亿分之15.7(效果大小:2.46),支气管反应性降低。RMT组无肺功能或反应性变化。
正压和呼吸锻炼能有效减轻肺部炎症,运动诱导的支气管痉挛(EIB),并加强了哮喘的临床控制,以及RMT,这也改善了临床控制。
Asthma is characterized by hyperresponsiveness of the airways, and exercise-induced bronchospasm (EIB) is a symptom that limits a large proportion of asthmatic patients, especially children. Continuous positive airway pressure (CPAP) leads to a reduction in the reactivity of the airways. The aim of this
study was to evaluate the effect of outpatient treatment with CPAP and bilevel pressure combined with respiratory physical therapy for children and adolescents with asthma following bronchial hyperresponsiveness caused by an exercise bronchoprovocation test.
A randomized, controlled, blind, clinical
trial was conducted involving 68 asthmatic children and adolescents aged 4 to 16 years divided into three groups: G1, treated with bilevel pressure (inspiratory positive airway pressure: 12 cm H2O; expiratory positive airway pressure: 8 cm H2O), G2, treated with CPAP (8 cm H2O) and G3, treated with respiratory muscle training (RMT), considered as the control group. All groups were treated at an outpatient clinic and submitted to 10 1-hour sessions, each of which also included respiratory exercises. Evaluations were performed before and after treatment and involved spirometry, an exercise bronchoprovocation test, respiratory pressures, fraction of nitric oxide (FeNO), the Asthma Control Questionnaire (ACQ6) and anthropometric variables. This
study received approval from the local ethics committee (certificate number: 1487225/2016) and is registered with ClinicalTrials [ ClinicalTrials.gov identifier: NCT02939625].
A total of 64 patients concluded the protocol; the mean age of the patients was 10 years. All were in the ideal weight range and had adequate height ( z score: -2 to +2). The three groups demonstrated improved asthma control after the treatments, going from partial to complete control. A significant increase in maximal inspiratory pressure occurred in the three groups, with the greatest increase in the RMT group. A reduction in FeNO in the order of 17.4 parts per billion (effect size: 2.43) and a reduction in bronchial responsiveness on the exercise bronchoprovocation test occurred in the bilevel group. An improvement in FeNO on the order of 15.7 parts per billion (effect size: 2.46) and a reduction in bronchial responsiveness occurred in the CPAP group. No changes in lung function or responsiveness occurred in the RMT group.
Positive pressure and respiratory exercises were effective in reducing pulmonary inflammation, exercise-innduced bronchoespasm (EIB), and increased the clinical control of asthma, as well as RMT, which also resulted in improved clinical control.