小児気管支喘息に対する吸入抗コリン薬の使用状況 : アレルギー専門小児科医を対象とした質問表による調査 A SURVEY ON THE CLINICAL USEFULNESS OF INHALED ANTICHOLINERGIC DRUGS FOR ASTHMATIC CHILDREN
本邦での小児喘息治療における吸入抗コリン薬の位置付けを明らかにする目的で, その使用状況に関する実態調査を行なった. 即ち, 日本アレルギー学会認定医の資格をもつ小児科医に質問表を送付し, 297名から回答を得た. このうち, 抗コリン薬の使用経験のある196名の回答を解析した. 抗コリン薬が有効な症例の頻度は,"しばしばあり"15%,"ときにあり"47%,"まれにあり"29%,"なし"10%であった. 有効例の年齢は, 小, 中学生との回答が多く, 乳幼児は少なかった. 抗コリン薬が有効な発作の誘因として, 冷気吸入, 天候の変化, 運動などが多く, 改善した症状としては, 咳嗽, 喘息発作が多かった. コントローラー, あるいはレリーバーとしての必要性は,"必要"が順に25%, 26%,"不必要"が順に20%, 27%,"どちらともいえない"が順に55%, 47%であった. 抗コリン薬液剤については約半数が"使ってみたい"と回答した. 抗コリン薬液剤は本邦では使用できないが, このことが乳幼児喘息に対する抗コリン薬の評価が低い理由の1つになっているのかもしれない.
In Japan, the strategy for the proper use of anticholinergic drugs in the management of childhood asthma is not established. Thus, we wanted to know how anticholinergic agents were used in the clinical practice. For the purpose, we prepared a questionnaire in which clinical effectiveness and the role of anticholinergic agents in the management of asthma were asked, and sent it to pediatricians who specialized allergy and clinical immunology. Among 297 pediatricians who answered the questionnaire, 196 pediatricians (66%) had the experience to prescribe anticholinergic drugs to their patients. Approximately 15% of them answered that they felt the drugs to be “frequently” effective, 47% did “sometimes” and 29% did “rarely”, and 10% did “not effective”. The majority of them answered that the agents were more effective for the students of primary and/or junior high school than infants or preschool children. Cold air inhalation, changes in the weather and exercise were found to be major factors of asthmatic attacks which could be prevented by anticholinergic drugs. It was found that these agents were more effective for the control of respiratory symptoms such as cough and asthmatic attacks than phlegm. Among 196 pediatricians, 25% and 26% of them answered that anticholinergic agents might be useful for asthmatic attacks as controller and reliever respectively, whereas 20% and 27% of them denied the usefulness, respectively. The rest of pediatricians answered that they could not determine the effectiveness. In Japan, we cannot use the anticholinergic drug by nebulizer because such product of this agent is not available now. Thus, it is possible that inability to use this drug by nebulizer may influence the answer that anticholinergic drugs are less effective for asthma in infants or younger children.
- 日本小児アレルギー学会誌 = The Japanese journal of pediatric allergy and clinical immunology
日本小児アレルギー学会誌 = The Japanese journal of pediatric allergy and clinical immunology 18(3), 270-278, 2004-08-01