儿科急诊用于哮喘急性发作的皮质类固醇药物的差异：一项PECARN注册研究
2026/04/02
摘要
背景：全身性皮质类固醇是哮喘急性发作治疗的标准组成部分。存在多种给药选择，但缺乏共识性推荐，导致不同医疗机构的治疗方案存在差异。
目的：研究2012 - 2024年用于治疗儿科哮喘急性发作的皮质类固醇治疗方案的差异，并确定与所使用皮质类固醇类型相关的社会人口统计学和临床特征。
方法：我们利用儿科急诊护理应用研究网络注册库，对2 - 17岁哮喘急性发作患儿的就诊情况进行了一项回顾性队列研究。采用中位数和四分位间距总结各医疗机构所使用皮质类固醇类型的频率。通过多变量逻辑回归，根据社会人口统计学和临床特征比较口服给予地塞米松与泼尼松的治疗情况，并对年份和临床医疗机构进行校正。
结果：分析纳入了17家医疗机构的206,388次就诊。总体而言，69.5%的就诊患儿接受了口服地塞米松治疗，24.7%接受了口服泼尼松/泼尼松龙治疗，4.8%接受了肌内/静脉注射甲泼尼龙治疗，1.0%接受了肌内/静脉注射地塞米松治疗。在整个研究期间，各医疗机构接受口服地塞米松治疗的就诊比例有所增加（p < 0.001）。年龄较小、西班牙裔种族和族裔、讲西班牙语以及有公共保险/自费的就诊患儿更有可能接受口服地塞米松治疗。急诊严重程度指数分诊级别为1级或2级、超重、哮喘发作严重程度为中度或有呼吸急促的就诊患儿更有可能接受泼尼松治疗。
结论：随着时间的推移，在哮喘急性发作管理中口服地塞米松的使用有所增加，且所使用的皮质类固醇类型因社会人口统计学和临床特征而异。未来的研究应探讨不同皮质类固醇治疗方案对临床结局的比较效果。
Variations in corticosteroids used for asthma exacerbations in the pediatric emergency department: A PECARN Registry Study
Adjoa A Andoh, Melisa S Tanverdi, Daniel J Shapiro, Matthew J Lipshaw, Anna M Cushing, Cody S Olsen, Huong D Meeks, Kathryn Morris, Julie C Leonard, Joseph J Zorc; Pediatric Emergency Care Applied Research Network PECARN
Abstract
Background: Systemic corticosteroids are a standard part of treatment for asthma exacerbations. Multiple options for administration exist without consensus recommendations, leading to variability in treatment regimens across sites.
Objective: To examine variation in corticosteroid regimens used to treat pediatric asthma exacerbations from 2012-2024 and identify sociodemographic and clinical characteristics associated with type of corticosteroid administered.
Methods: We performed a retrospective cohort study of encounters of children ages 2-17 years with asthma exacerbations using the Pediatric Emergency Care Applied Research Network Registry. Frequencies of corticosteroid types administered by site were summarized using median and interquartile ranges. Multivariable logistic regression compared treatment with enteral dexamethasone versus enteral prednisone by sociodemographic and clinical characteristics, adjusting for year and clinical site.
Results: The analysis included 206,388 encounters over 17 sites. Overall, 69.5% of encounters received enteral dexamethasone, 24.7% enteral prednisone/prednisolone, 4.8% intramuscular/intravenous methylprednisolone and 1.0% intramuscular/intravenous dexamethasone. There was an increase in the proportion of encounters receiving enteral dexamethasone at sites throughout the study period (p<0.001). Encounters with younger age, Hispanic race and ethnicity, Spanish language, and public insurance/self-pay were more likely to received enteral dexamethasone. Encounters with emergency severity index triage level 1 or 2, who were overweight, had moderate exacerbation severity, or with tachypnea were more likely to receive prednisone.
Conclusion: Use of enteral dexamethasone in the management of asthma exacerbations has increased over time, and the type of corticosteroid administered varied by sociodemographic and clinical characteristics. Future studies should explore the comparative effectiveness of different corticosteroid regimens on clinical outcomes.
背景：全身性皮质类固醇是哮喘急性发作治疗的标准组成部分。存在多种给药选择，但缺乏共识性推荐，导致不同医疗机构的治疗方案存在差异。
目的：研究2012 - 2024年用于治疗儿科哮喘急性发作的皮质类固醇治疗方案的差异，并确定与所使用皮质类固醇类型相关的社会人口统计学和临床特征。
方法：我们利用儿科急诊护理应用研究网络注册库，对2 - 17岁哮喘急性发作患儿的就诊情况进行了一项回顾性队列研究。采用中位数和四分位间距总结各医疗机构所使用皮质类固醇类型的频率。通过多变量逻辑回归，根据社会人口统计学和临床特征比较口服给予地塞米松与泼尼松的治疗情况，并对年份和临床医疗机构进行校正。
结果：分析纳入了17家医疗机构的206,388次就诊。总体而言，69.5%的就诊患儿接受了口服地塞米松治疗，24.7%接受了口服泼尼松/泼尼松龙治疗，4.8%接受了肌内/静脉注射甲泼尼龙治疗，1.0%接受了肌内/静脉注射地塞米松治疗。在整个研究期间，各医疗机构接受口服地塞米松治疗的就诊比例有所增加（p < 0.001）。年龄较小、西班牙裔种族和族裔、讲西班牙语以及有公共保险/自费的就诊患儿更有可能接受口服地塞米松治疗。急诊严重程度指数分诊级别为1级或2级、超重、哮喘发作严重程度为中度或有呼吸急促的就诊患儿更有可能接受泼尼松治疗。
结论：随着时间的推移，在哮喘急性发作管理中口服地塞米松的使用有所增加，且所使用的皮质类固醇类型因社会人口统计学和临床特征而异。未来的研究应探讨不同皮质类固醇治疗方案对临床结局的比较效果。
（中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校）
（J Allergy Clin Immunol Pract. 2026 Mar 19:S2213-2198(26)00211-4. doi: 10.1016/j.jaip.2026.03.010. ）
（J Allergy Clin Immunol Pract. 2026 Mar 19:S2213-2198(26)00211-4. doi: 10.1016/j.jaip.2026.03.010. ）
Variations in corticosteroids used for asthma exacerbations in the pediatric emergency department: A PECARN Registry Study
Adjoa A Andoh, Melisa S Tanverdi, Daniel J Shapiro, Matthew J Lipshaw, Anna M Cushing, Cody S Olsen, Huong D Meeks, Kathryn Morris, Julie C Leonard, Joseph J Zorc; Pediatric Emergency Care Applied Research Network PECARN
Abstract
Background: Systemic corticosteroids are a standard part of treatment for asthma exacerbations. Multiple options for administration exist without consensus recommendations, leading to variability in treatment regimens across sites.
Objective: To examine variation in corticosteroid regimens used to treat pediatric asthma exacerbations from 2012-2024 and identify sociodemographic and clinical characteristics associated with type of corticosteroid administered.
Methods: We performed a retrospective cohort study of encounters of children ages 2-17 years with asthma exacerbations using the Pediatric Emergency Care Applied Research Network Registry. Frequencies of corticosteroid types administered by site were summarized using median and interquartile ranges. Multivariable logistic regression compared treatment with enteral dexamethasone versus enteral prednisone by sociodemographic and clinical characteristics, adjusting for year and clinical site.
Results: The analysis included 206,388 encounters over 17 sites. Overall, 69.5% of encounters received enteral dexamethasone, 24.7% enteral prednisone/prednisolone, 4.8% intramuscular/intravenous methylprednisolone and 1.0% intramuscular/intravenous dexamethasone. There was an increase in the proportion of encounters receiving enteral dexamethasone at sites throughout the study period (p<0.001). Encounters with younger age, Hispanic race and ethnicity, Spanish language, and public insurance/self-pay were more likely to received enteral dexamethasone. Encounters with emergency severity index triage level 1 or 2, who were overweight, had moderate exacerbation severity, or with tachypnea were more likely to receive prednisone.
Conclusion: Use of enteral dexamethasone in the management of asthma exacerbations has increased over time, and the type of corticosteroid administered varied by sociodemographic and clinical characteristics. Future studies should explore the comparative effectiveness of different corticosteroid regimens on clinical outcomes.
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用于哮喘治疗的非炎性脂质纳米粒沉默肺内积聚的黏液蛋白5AC
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大环内酯类药物治疗哮喘：一项随机试验的系统评价与meta分析
