哮喘联盟

   摘要
   背景：已知吸入皮质激素是治疗慢性哮喘的有效维持药物，高剂量时也被建议用于急性哮喘的治疗。
   方法：一项双盲、随机、安慰剂对照试验纳入了2～12岁中重度急性哮喘儿童，哮喘严重程度基于5～15分临床评分而确定，15分为最严重。本研究中比较了急性哮喘标准治疗中加用布地奈德1500 mcg或安慰剂雾化治疗的疗效，标准治疗方案包括沙丁胺醇、异丙托溴铵和治疗开始时给予单剂量泼尼松龙2mg/kg。主要结果为4小时内的住院率。
   结果：共纳入906例急诊室中重度急性哮喘儿童。458例中75例(16.4%)纳入布地奈德组，82/448(18.3%)纳入安慰剂组，(OR 0.84, 95% CI 0.58 - 1.23,P=0.38)。在基线高临床评分(≥13)的儿童中，布地奈德组的儿童住院率27/76 (35.5%)显著低于安慰剂组39/73 (53.4%)(OR 0.42, 95% CI 0.19 - 0.94, P= 0.03)。
   结论：联合布地奈德雾化治疗并未减少急性哮喘儿童的总体住院率。不过可能有助于减少重度急性哮喘儿童的住院率。
 

（苏楠 审校）
Chest. 2014 Jan 2. doi: 10.1378/chest.13-2298. [Epub ahead of print]

Budesonide Nebulization Added to Systemic Prednisolone in The Treatment of Acute Asthma in Children: Double-Blind, Randomized, Controlled Trial.
 

Alangari AA, Malhis N, Mubasher M, Al-Ghamedi N, Al-Tannir M, Riaz M, Umetsu DT, Al-Tamimi S.
 

Abstract
BACKGROUND: Inhaled corticosteroids, known to be effective as a maintenance medication in chronic asthma, have also been suggested as a therapy for acute asthma, when given at high doses.
METHODS: A double blind, randomized, placebo controlled trial was conducted in children 2-12 years of age with moderate or severe acute asthma, as determined based on 5-15 points clinical score, where 15 is the most severe. We compared the addition of budesonide 1500 mcg versus placebo to standard acute asthma treatment, which included salbutamol, ipratropium bromide and a single dose of prednisolone 2 mg/kg given at the beginning of therapy. The primary outcome was admission rate within 4 hours.
RESULTS: A total of 906 emergency department visits of children with moderate or severe acute asthma were evaluated. Seventy-five cases out of 458 (16.4%) in the budesonide group versus 82/448 (18.3%) in the placebo group were admitted, (OR 0.84, 95% CI 0.58 to 1.23, p-value=0.38). However, among cases with high baseline clinical score (≥13), significantly fewer children were admitted in the budesonide group 27/76 (35.5%) than in the placebo group 39/73 (53.4%) (OR 0.42, 95% CI 0.19 to 0.94, p-value= 0.03).
CONCLUSION: The addition of budesonide nebulization did not decrease the admission rate of children with acute asthma overall. However, it may decrease the admission rate of children with severe acute asthma.
 

Chest. 2014 Jan 2. doi: 10.1378/chest.13-2298. [Epub ahead of print]