哮喘联盟

    目的：对比吸入糖皮质激素在治疗复发性喘息和哮喘婴儿及学龄前儿童的有效性。
    方法：收集1996年1月～2008年3月之间发表在Medline、Embase和 Central databases上有关吸入糖皮质激素与安慰剂对照治疗至少4周的随机、前瞻、病例对照研究。首要终点为喘息/哮喘加重；次要终点为由于撤药而引起的喘息/哮喘的加重、症状评分改变、肺功能（最大呼气流量和第1秒用力呼吸量）或沙丁胺醇的使用。
    结果：共获得83项研究，其中29项（3592例受试者）符合标准。与安慰剂相比，使用吸入糖皮质激素治疗的患者喘息/哮喘加重明显减少（18.0% vs 32.1%）。因此，亚组分析显示这一效果在诊断为哮喘的患儿中疗效优于诊断为喘息的患者，但依赖于患者年龄、变应性情况、吸入糖皮质激素的类型（布地奈德定量定压式气雾器vs.氟替卡松定量定压式气雾器）、给药方式（量定压式气雾器vs.雾化器）、研究质量（Jadad评分：<4 vs. >/=4）和持续时间（<12 vs >/=12 weeks）。而且，与安慰剂相比，使用吸入糖皮质激素治疗的儿童较少因撤药而引起喘息/哮喘的加重、较少使用沙丁胺醇，而临床症状和肺功能显著改善。
    结论：喘息或哮喘复发的婴儿和学龄前儿童在吸入糖皮质激素治疗期间喘息/哮喘加重明显减少，并且能改善症状和肺功能。

                                                （苏楠 审校）
Castro-Rodriguez JA,et al. Pediatrics. 2009 Mar;123(3):e519-525.

Efficacy of inhaled corticosteroids in infants and preschoolers with recurrent wheezing and asthma: a systematic review with meta-analysis.

OBJECTIVE: To compare the efficacy of inhaled corticosteroids in infants and preschoolers with recurrent wheezing or asthma.
METHODS: Randomized, prospective, controlled trials published January 1996 to March 2008 with a minimum of 4 weeks of inhaled corticosteroids versus placebo were retrieved through Medline, Embase, and Central databases. The primary outcome was wheezing/asthma exacerbations; secondary outcomes were withdrawal caused by wheezing/asthma exacerbations, changes in symptoms score, pulmonary function (peak expiratory flow and forced expiratory volume in 1 second), or albuterol use.
RESULTS: Of eighty-nine studies identified, 29 (N = 3592 subjects) met the criteria for inclusion. Patients who received inhaled corticosteroids had significantly less wheezing/asthma exacerbations than those on placebo (18.0% vs 32.1%); posthoc subgroup analysis suggests that this effect was higher in those with a diagnosis of asthma than wheeze but was independent of age (infants versus preschoolers), atopic condition, type of inhaled corticosteroid (budesonide metered-dose inhaler versus fluticasone metered-dose inhaler), mode of delivery (metered-dose inhaler versus nebulizer), and study quality (Jadad score: <4 vs >/=4) and duration (<12 vs >/=12 weeks). In addition, children treated with inhaled corticosteroids had significantly fewer withdrawals caused by wheezing/asthma exacerbations, less albuterol use, and more clinical and functional improvement than those on placebo.
CONCLUSIONS: Infants and preschoolers with recurrent wheezing or asthma had less wheezing/asthma exacerbations and improve their symptoms and lung function during treatment with inhaled corticosteroids.