Rachelefsky Gary
Allergy Research Foundation, Inc, Los Angeles, California, USA.
Pediatrics. 2003 Aug;112(2):382-97. doi: 10.1542/peds.112.2.382.
To review the use of systemic corticosteroids to treat recurrent, acute asthma episodes in children, with a focus on the role of oral corticosteroids.
A comprehensive review of the literature was performed using the Medline database (January 1966-October 2002) and the Embase database (January 1980-August 2002).
The significant findings of 17 selected, controlled clinical trials of oral corticosteroids (OCSs) for acute exacerbations of asthma in children, compared with placebo or with other formulations of corticosteroids, can be summarized as follows: 1) OCSs are effective for the outpatient treatment of acute asthma, 2) pulmonary function tests may not be the best means of assessing the efficacy of OCSs for acute asthma, 3) early administration of OCSs for acute asthma reduces hospitalizations, 4) the critical factor for a positive outcome is early administration of the corticosteroid, and 5) OCSs are preferred for the outpatient treatment of acute asthma.
Early treatment of acute asthma symptoms with OCSs in children with a pattern of recurrent acute asthma may decrease the severity of acute asthma episodes and reduce the likelihood of subsequent relapses. Attention should be given to identifying these children and standardizing a treatment approach based on accepted, consistent definitions of what constitutes an asthma exacerbation and recurrence. A suggested protocol is described.
回顾全身用糖皮质激素治疗儿童复发性急性哮喘发作的应用情况，重点关注口服糖皮质激素的作用。
使用Medline数据库（1966年1月至2002年10月）和Embase数据库（1980年1月至2002年8月）对文献进行全面回顾。
17项入选的关于口服糖皮质激素（OCSs）治疗儿童哮喘急性加重的对照临床试验的重要发现，与安慰剂或其他糖皮质激素制剂相比，可总结如下：1）OCSs对门诊急性哮喘治疗有效；2）肺功能测试可能不是评估OCSs治疗急性哮喘疗效的最佳手段；3）急性哮喘早期给予OCSs可减少住院率；4）治疗取得阳性结果的关键因素是早期给予糖皮质激素；5）门诊急性哮喘治疗首选OCSs。
对于有复发性急性哮喘发作模式的儿童，早期用OCSs治疗急性哮喘症状可能会减轻急性哮喘发作的严重程度，并降低随后复发的可能性。应注意识别这些儿童，并根据关于哮喘加重和复发的公认、一致定义规范治疗方法。描述了一个建议方案。
