Rittichier Kristine Kay
Emergency Department, Primary Children's Medical Center, University of Utah, Salt Lake City, 84311, USA.
Treat Respir Med. 2004;3(3):139-45. doi: 10.2165/00151829-200403030-00002.
Since the 1960s, corticosteroids have been used in the treatment of laryngotracheobronchitis, commonly called croup. Initially, their use for croup was controversial and highly debated in the literature. The evidence over the last 2 decades has strongly favored corticosteroid use in croup management. It has now become the standard of care to use corticosteroids in moderate-to-severe croup. Corticosteroid use in these patients has been shown to reduce hospitalizations, length of illness, and subsequent treatments when compared with placebo. By extrapolation, corticosteroids may even play a role in patients with milder croup presenting for medical assessment. The current recommendation is to treat patients with moderate-to-severe croup with oral dexamethasone in a dose of 0.6 mg/kg (maximum 10-12 mg) because of its ease of administration, easy availability, and low cost. Intramuscular dexamethasone is reserved for patients who are vomiting or who are in severe respiratory distress and unable to tolerate oral medication. Nebulized budesonide, used commonly in some geographic locations, has been found to be effective, but is often not used in favor of the oral corticosteroids. Controversy still exists over the use of corticosteroids in mild and potentially self-limiting disease. Some evidence exists for treating these patients; some clinicians use corticosteroids for all patients with croup who seek care regardless of the severity of the illness. Patients with mild disease may be candidates for lower doses of dexamethasone such as 0.15-0.3 mg/kg. Corticosteroid-induced complications in croup are rare. Overall, corticosteroids have gained universal acceptance for the treatment of croup and have been found to be effective, well tolerated, and inexpensive.
自20世纪60年代以来，皮质类固醇一直用于治疗喉气管支气管炎，通常称为哮吼。最初，其在哮吼治疗中的应用存在争议，在文献中引发了激烈讨论。过去20年的证据强烈支持在哮吼管理中使用皮质类固醇。如今，在中重度哮吼中使用皮质类固醇已成为标准治疗方法。与安慰剂相比，在这些患者中使用皮质类固醇已显示可减少住院次数、疾病持续时间和后续治疗。由此推断，皮质类固醇甚至可能在前来进行医学评估的轻度哮吼患者中发挥作用。目前的建议是，对于中重度哮吼患者，使用剂量为0.6 mg/kg（最大剂量10 - 12 mg）的口服地塞米松进行治疗，因为其给药方便、容易获得且成本低。肌肉注射地塞米松适用于呕吐或处于严重呼吸窘迫且无法耐受口服药物的患者。在一些地区常用的雾化布地奈德已被证明有效，但通常不使用，而更倾向于口服皮质类固醇。在轻度和可能自限性疾病中使用皮质类固醇仍存在争议。有一些证据支持治疗这些患者；一些临床医生对所有寻求治疗的哮吼患者都使用皮质类固醇，而不论疾病的严重程度如何。轻度疾病患者可能适合使用较低剂量的地塞米松，如0.15 - 0.3 mg/kg。哮吼中皮质类固醇引起的并发症很少见。总体而言，皮质类固醇已被广泛接受用于治疗哮吼，并且已被发现有效、耐受性良好且成本低廉。
