Smith M, Iqbal S, Elliott T M, Everard M, Rowe B H
Paediatric Department, Craigavon Area Hospital Group Trust, 68 Lurgan Road, Craigavon, Northern Ireland, UK, BT63 5QQ.
Cochrane Database Syst Rev. 2003;2003(2):CD002886. doi: 10.1002/14651858.CD002886.
Systemic corticosteroids are used routinely in the management of children with severe acute asthma. There is a lack of consensus regarding the agent, dose and route of corticosteroid administration.
To determine the benefit of systemic corticosteroids (oral, intravenous, or intramuscular) compared to placebo and inhaled steroids in acute paediatric asthma.
All controlled trials were identified from the Cochrane Airways Review Group Register, hand searching of respiratory journals, reference lists and contacts with experts and pharmaceutical companies.
Studies were included if they described a randomised controlled trial (RCT) involving children aged 1-18 years with severe acute asthma who received oral, inhaled, intravenous or intramuscular corticosteroids. Only studies in which patients required hospital admission were included.
Two reviewers using a standard form extracted all data. All data, numeric calculations and graphic extrapolations were independently confirmed.
Seven trials were included with a total of 426 children studied (274 with oral prednisone vs. placebo, 106 with intravenous steroids vs placebo and 46 with nebulised budesonide vs prednisolone). A significant number of steroid treated children were discharged early after admission (>4 hours) with an OR of 7.00 (95% CI: 2.98 to 16.45) and NNT of 3 (95%CI: 2 to 8). The length of stay was shorter in the steroid groups with a WMD of -8.75 hours (95% CI: -19.23 to 1.74). There were no significant differences between groups in pulmonary function or oxygen saturation measurements. Children treated with steroids in hospital were less likely to relapse within one to three months with OR 0.19 (95%CI: 0.07 to 0.55) and NNT of 3 (95%CI: 2 to 7). The single small study that compared nebulised budesonide to oral prednisone failed to demonstrate equivalence or a difference between each therapy.
REVIEWER'S CONCLUSIONS: Systemic corticosteroids produce some improvements for children admitted to hospital with acute asthma. The benefits may include earlier discharge and fewer relapses. Inhaled or nebulised corticosteroids cannot be recommended as equivalent to systemic steroids at this time. Further studies examining differing doses and routes of administration for corticosteroids will clarify the optimal therapy.
全身用糖皮质激素常用于重症急性哮喘儿童的治疗。关于糖皮质激素的用药种类、剂量及给药途径，目前尚无共识。
比较全身用糖皮质激素（口服、静脉或肌肉注射）与安慰剂及吸入性糖皮质激素在儿童急性哮喘治疗中的疗效。
从Cochrane气道综述组注册库、手工检索呼吸领域期刊、参考文献列表以及与专家和制药公司联系等途径，识别所有对照试验。
纳入描述了涉及1 - 18岁重症急性哮喘儿童的随机对照试验（RCT），这些儿童接受口服、吸入、静脉或肌肉注射糖皮质激素治疗。仅纳入患者需要住院治疗的研究。
两名评价员使用标准表格提取所有数据。所有数据、数值计算和图表推断均独立进行了确认。
共纳入7项试验，总计426名儿童（274名接受口服泼尼松与安慰剂对比，106名接受静脉用糖皮质激素与安慰剂对比，46名接受布地奈德雾化吸入与泼尼松龙对比）。大量接受糖皮质激素治疗的儿童在入院后4小时以上提前出院，比值比为7.00（95%可信区间：2.
