哮喘联盟

   摘要
   目标：较吸入糖皮质激素（ICS）和全身给予糖皮质激素（SC）在急诊科（ED）或相当于哮喘急性发作患儿中的疗效。
   方法：在MEDLINE, CENTRAL, CINAHL和 LILACS 数据库和其它来源进行在线检索。研究纳入标准：2～18岁儿童，急诊科或相当于哮喘急性发作，比较ICS和SC，随机对照试验。主要终点：住院率、计划外的因哮喘症状看病次数、需要额外补充SC治疗。次要终点：肺功能改善、ED住院时间、临床评分和不良反应。
   结果：8篇研究符合纳入标准（N=797），发表于1995-2006年间。所有研究均采用泼尼松龙作为SC用药，布地奈德、氟替卡松、地塞米松和氟尼缩松作为ICS用药。ICS和SC在住院率(RR: 1.02; 95% CI: 0.41-2.57)、计划外的因哮喘症状看病次数(RR: 9.55; 95% CI: 0.53-170.52) 和需要额外补充SC治疗(RR: 1.45; 95% CI: 0.28-7.62)方面无明显差异。4小时时，SC组预测FEV1变化百分比显著增高，但4小时后两组预测FEV1均无明显差异。尚无足够数据以进行首次ED住院时间和症状评分的meta-分析。两组呕吐情况相似。
   结论：在哮喘急性发作患儿中，ICS和SC两组间在住院率、计划外的因哮喘症状看病次数和需要额外补充SC治疗方面无明显差异。
 

（苏楠 审校）
Pediatr Pulmonol. 2013 Aug 8. doi: 10.1002/ppul.22846. [Epub ahead of print]

 

Inhaled versus systemic corticosteroids for acute asthma in children. A systematic review.
 

Beckhaus AA, Riutort MC, Castro-Rodriguez JA.
 

Abstract
OBJECTIVE: To compare the effects of inhaled corticosteroids (ICS) against systemic corticosteroids (SC) in children consulting in emergency department (ED) or equivalent for asthma exacerbation.
METHODS: Electronic search in MEDLINE, CENTRAL, CINAHL, and LILACS databases and other sources. Study selection criteria: children 2-18 years of age, consulting in ED or equivalent for asthma exacerbation, comparison between ICS and SC, randomized controlled trials. Primary outcomes: hospital admission rate, unscheduled visits for asthma symptoms, need of additional course of SC. Secondary outcomes: improvement of lung function, length of stay in ED, clinical scores, and adverse effects.
RESULTS: Eight studies met inclusion criteria (N = 797), published between 1995 and 2006. All used prednisolone as SC and budesonide, fluticasone, dexamethasone, and flunisolide were administered as ICS. No significant difference between ICS versus SC was found in terms of hospital admission (RR: 1.02; 95% CI: 0.41-2.57), unscheduled visits for asthma symptoms (RR: 9.55; 95% CI: 0.53-170.52) nor for need of additional course of SC (RR: 1.45; 95% CI: 0.28-7.62). The change in % of predicted FEV1 at fourth hour was significantly higher for SC group, but there was no significant difference between both groups after this time. There was insufficient data to perform meta-analysis of length of stay during first consult in ED and of symptom scores. Vomiting was similar among both groups.
CONCLUSIONS: There is no evidence of a difference between ICS and SC in terms of hospital admission rates, unscheduled visits for asthma symptoms and need of additional course of SC in children consulting for asthma exacerbations.
 

Pediatr Pulmonol. 2013 Aug 8. doi: 10.1002/ppul.22846. [Epub ahead of print]