McKean M, Ducharme F
Department of Child Health, University of Leicester, Robert Kilpatrick Clinical Sciences Building, Royal Infirmary P.O. Box 65, Leicester, UK, LE2 7LX.
Cochrane Database Syst Rev. 2000;2000(2):CD001107. doi: 10.1002/14651858.CD001107.
Recurrent episodic wheeze in association with viral upper respiratory tract infection (URTI) is a specific clinical illness distinct from persistent atopic asthma.
The objective of this review was to identify whether corticosteroid treatment, given episodically or daily, is beneficial to children with viral episodic wheeze.
We searched the Cochrane Airways Group trials register and reference lists of articles.
Randomised controlled trials (RCTs) of corticosteroid treatment versus placebo in children under 17 years of age who suffer from 'episodic viral wheeze', which is defined by wheeze in association with coryzal symptoms with minimal or no intercurrent lower respiratory tract symptoms.
Trial quality was assessed independently by two reviewers. Study authors were contacted for missing information. Studies were categorised according to whether treatment was given episodically or daily (maintenance). The primary outcome was episodes requiring oral corticosteroids. Secondary outcomes addressed episode severity, frequency and duration and parental treatment preference.
Five randomised controlled trials in children with a history of mild episodic viral wheeze were identified. Most of the children had previously required no or infrequent oral corticosteroids and had very infrequent hospital admissions. There were three studies of preschool children given episodic high dose inhaled corticosteroid (1.6 - 2.25 mg per day), two using a crossover and one a parallel design. The two studies of maintenance corticosteroid (400 micrograms per day) were parallel in design, one of pre-school children the other of children aged 7 -9 years. Results from the two cross-over studies of episodic high dose inhaled corticosteroids showed a reduced requirement for oral corticosteroids (Relative risk (RR)=0.53, 95% CI: 0.27, 1.04). In these 2 double blind studies, this treatment was preferred by the children's parents over placebo (RR=0.64, 95% CI: 0.48,0.87). Maintenance low dose inhaled corticosteroids did not show any clear reduction over placebo in the proportion of episodes requiring oral corticosteroids (N=2 trials, RR=0.82, 95%CI: 0.23,2.90) or in those requiring hospital admission (N=1 trial, RR=0.21, 95% CI: 0.01,4.11).
REVIEWER'S CONCLUSIONS: Episodic high dose inhaled corticosteroids provide a partially effective strategy for the treatment of mild episodic viral wheeze of childhood. There is no current evidence to favour maintenance low dose inhaled corticosteroids in the prevention and management of episodic mild viral induced wheeze.
复发性发作性喘息伴病毒性上呼吸道感染（URTI）是一种有别于持续性特应性哮喘的特定临床疾病。
本综述的目的是确定间歇性或每日给予皮质类固醇治疗对病毒性发作性喘息儿童是否有益。
我们检索了Cochrane气道组试验注册库和文章的参考文献列表。
针对17岁以下患有“发作性病毒性喘息”儿童的皮质类固醇治疗与安慰剂的随机对照试验（RCT），“发作性病毒性喘息”定义为喘息伴卡他症状且下呼吸道并发症状极少或无。
由两名评价者独立评估试验质量。联系研究作者获取缺失信息。根据治疗是间歇性给予还是每日给予（维持治疗）对研究进行分类。主要结局是需要口服皮质类固醇的发作次数。次要结局涉及发作的严重程度、频率和持续时间以及家长的治疗偏好。
确定了五项针对有轻度发作性病毒性喘息病史儿童的随机对照试验。大多数儿童以前不需要或很少需要口服皮质类固醇，住院次数也极少。有三项针对学龄前儿童的研究给予间歇性高剂量吸入皮质类固醇（每天1.6 - 2.25毫克），两项采用交叉设计，一项采用平行设计。两项维持性皮质类固醇（每天400微克）研究采用平行设计，一项针对学龄前儿童，另一项针对7 - 9岁儿童。两项间歇性高剂量吸入皮质类固醇交叉研究的结果显示口服皮质类固醇的需求减少（相对危险度（RR）=0.53，95%可信区间：0.27，1.04）。在这两项双盲研究中，与安慰剂相比，这种治疗更受儿童家长青睐（RR=0.64，95%可信区间：0.48，0.87）。维持性低剂量吸入皮质类固醇在需要口服皮质类固醇的发作比例（N = 2项试验，RR = 0.82，95%可信区间：0.23，2.90）或需要住院的发作比例（N = 1项试验，RR = 0.21，95%可信区间：0.01，4.11）方面，与安慰剂相比未显示出明显降低。
间歇性高剂量吸入皮质类固醇为治疗儿童轻度发作性病毒性喘息提供了一种部分有效的策略。目前没有证据支持在预防和管理发作性轻度病毒诱发喘息方面使用维持性低剂量吸入皮质类固醇。
