Objective: To study the clinical effect of different combinations of fluticasone propionate (Flu), montelukast sodium (Mon) and ketotifen (Ket) in the treatment of children with cough variant asthma (CVA).
Methods: A total of 280 children with CVA who were admitted to the department of respiratory medicine from June 2015 to January 2018 were randomly divided into Flu+Mon+Ket, Flu+Mon, Flu+Ket, Mon+Ket, Flu, Mon and Ket groups, with 40 children in each group. The children in each group were given corresponding drug(s), and the course of treatment was 3 months for all groups. The condition of cough, cough symptom score, pulmonary function and adverse drug reactions were evaluated after 2 and 3 months of treatment. The children were followed up to observe recurrence.
Results: After treatment, cough symptom score tended to decrease in all 7 groups, with increases in percentage of forced expiratory volume in 1 second (FEV1%) and percentage of predicted peak expiratory flow (PEF%). After 2 months of treatment, the Flu+Mon+Ket group had a significantly lower cough symptom score and significantly higher FEV1% and PEF% than the other groups (P<0.05). After 2 and 3 months of treatment, the Ket group had a significantly higher cough symptom score and significantly lower FEV1% and PEF% than the other groups (P<0.05). After 3 months of treatment, there were no significant differences in cough symptom score, FEV1% and PEF% among the other groups (P>0.05). There was a low incidence rate of adverse events in all 7 groups, and there was no significant difference among the 7 groups (P>0.05). The Ket group had a significantly higher recurrence rate of cough than the other groups (P<0.001), while there was no significant difference in this rate among the other groups (P>0.0024).
Conclusions: For children with CVA, a combination of Flu, Mon and Ket has a better clinical effect than a combination of two drugs and a single drug at 2 months of treatment and is safe. After 3 months of treatment, Flu or Mon alone has a similar effect to drug combination. Ket alone has a poor clinical effect and a high recurrence rate after drug withdrawal.
目的: 观察丙酸氟替卡松（Flu）、孟鲁斯特钠（Mon）与酮替芬（Ket）的不同联合用药方案治疗儿童咳嗽变异性哮喘（CVA）的效果。
方法: 将2015年6月至2018年1月于呼吸科门诊收治的280例CVA患儿随机分为Flu+Mon+Ket组、Flu+Mon组、Flu+Ket组、Mon+Ket组、Flu组、Mon组、Ket组（n=40）。每组根据各自的用药方案给予相应药物，疗程均为3个月。评估患儿在治疗后2个月及3个月时的咳嗽情况及评分、肺功能和药物不良反应，并随访复发情况。
结果: 随治疗时间，7组患儿咳嗽评分均呈下降趋势，第1秒用力呼气容积占预计值的百分比（FEV1%）、最大呼气流量占预计值的百分比（PEF%）均呈上升趋势。治疗2个月后，Flu+Mon+Ket组咳嗽评分均低于其他组，FEV1%、PEF%均高于其他组（P < 0.05）；治疗2个月后及治疗3个月后，Ket组咳嗽评分明显高于其他组，FEV1%、PEF%明显低于其他组（P < 0.05）；其他各组在治疗3个月后，组间咳嗽评分、FEV1%、PEF%比较差异均无统计学意义（P > 0.05）。7组不良反应发生率低且差异无统计学意义（P > 0.05）。Ket组咳嗽复发率明显高于其他组（P < 0.001），其他各组间咳嗽复发率比较差异无统计学意义（P > 0.0024）。
结论: Flu、Mon、Ket三药联合使用治疗儿童CVA在2个月时的疗效较两药联用及单药使用显著，且用药安全；但用药3个月后，单用Flu或单用Mon的疗效不差于联合用药；单用Ket疗效不佳，且停药后复发率较高。