Vuillermin P, South M, Robertson C
Royal Children's Hospital, Melbourne & Geelong Hospital, Melbourne, Australia.
Cochrane Database Syst Rev. 2006 Jul 19;2006(3):CD005311. doi: 10.1002/14651858.CD005311.pub2.
Intermittent wheezing illnesses, which include viral associated wheeze and asthma, are amongst the most common reasons for children to present urgently to a doctor. Whether parents should commence oral corticosteroids (OCS) for an episode of acute wheeze in their child without waiting for a medical review is an important question, as the potential benefits of early oral corticosteroid intervention have to be weighed against the potential adverse effects of treatment.
The objectives were to assess the benefits and harmful effects of parent-initiated OCS, in the management of intermittent wheezing illnesses in children, based on the results of randomised clinical trials.
The Cochrane Airways Group Specialised Register, The Cochrane Controlled Trials Register (CENTRAL), MEDLINE, EMBASE, LILACS, Web of Science and Dissertation Abstracts were combined (all searched November 2005). Manufacturers and researchers in the field were also contacted.
Only randomised clinical trials studying patients aged between one and eighteen years old, with an intermittent wheezing illness (asthma, viral wheeze, preschool viral wheeze) were included. Interventions encompassed OCS at any dose or duration versus placebo or other drug combination. The trials could be unpublished or published and no language limitations were applied.
Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data. The statistical package (RevMan 4.2) provided by the Cochrane Collaboration was used.
From 572 original citations, a total of 2 randomised clinical trials (303 randomised participants) were included. The quality of the included trials was high; however, marked clinical heterogeneity precluded a meta-analysis. The two trials did not find evidence that parent-initiated OCS are associated with a benefit in terms of hospital admissions, unscheduled medical reviews, symptoms scores, bronchodilator use, parent and patient impressions, physician assessment, or days lost from work or school. Adverse outcomes were inadequately documented.
AUTHORS' CONCLUSIONS: Limited current evidence is available and it is inconclusive regarding the benefit from parent-initiated OCS in the treatment of intermittent wheezing illnesses in children. Widespread use of this strategy cannot be recommended until the benefits and harms can be clarified further.
间歇性喘息疾病，包括病毒相关性喘息和哮喘，是儿童急需看医生的最常见原因之一。家长是否应在不等候医学评估的情况下就为孩子的急性喘息发作开始使用口服糖皮质激素（OCS）是一个重要问题，因为早期口服糖皮质激素干预的潜在益处必须与治疗的潜在不良反应相权衡。
基于随机临床试验的结果，评估家长自行启动使用OCS对儿童间歇性喘息疾病治疗的益处和有害影响。
将Cochrane气道组专业注册库、Cochrane对照试验注册库（CENTRAL）、MEDLINE、EMBASE、LILACS、科学引文索引和学位论文摘要进行合并（均检索于2005年11月）。还联系了该领域的制造商和研究人员。
仅纳入研究年龄在1至18岁之间、患有间歇性喘息疾病（哮喘、病毒相关性喘息、学龄前病毒相关性喘息）患者的随机临床试验。干预措施包括任何剂量或疗程的OCS与安慰剂或其他药物组合的对比。试验可以未发表或已发表，且不设语言限制。
两名评价员独立选择纳入试验、评估试验质量并提取数据。使用Cochrane协作网提供的统计软件包（RevMan 4.2）。
从572条原始文献中，共纳入2项随机临床试验（303名随机参与者）。纳入试验的质量较高；然而，显著的临床异质性妨碍了进行荟萃分析。这两项试验未发现证据表明家长自行启动使用OCS在住院、非计划的医学评估、症状评分、支气管扩张剂使用、家长和患者的印象、医生评估或误工或误学天数方面有获益。不良结局的记录不充分。
目前可用的证据有限，关于家长自行启动使用OCS治疗儿童间歇性喘息疾病的获益尚无定论。在益处和危害能进一步明确之前，不建议广泛使用这一策略。
