Vuillermin Peter J, Robertson Colin F, South Mike
Murdoch Children's Research Institute, and Department of Paediatrics, University of Melbourne, Melbourne, Australia.
J Paediatr Child Health. 2007 Jun;43(6):438-42. doi: 10.1111/j.1440-1754.2007.01107.x.
Intermittent wheezing illnesses, which include viral-associated wheeze and asthma, are among the most common reasons for children to present urgently to a doctor. The objectives of this systematic review were to assess the benefits and harmful effects of parent-initiated oral corticosteroids (PIOCS) in the management of intermittent wheezing illness in children.
The Cochrane Airways Group Specialised Register, The Cochrane Controlled Trials Register (CENTRAL), MEDLINE, EMBASE, LILACS, Web of Science and Dissertation Abstracts were searched. Only randomised clinical trials studying patients aged between 1 and 18 years, with an intermittent wheezing illness were included.
From 572 original citations, a total of two 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 PIOCS are associated with a benefit in terms of hospital admissions, unscheduled medical reviews, symptoms scores, or bronchodilator use.
Limited current evidence is available and it is inconclusive regarding the benefit from PIOCS therapy in the treatment of intermittent wheezing illnesses in children. Oral corticosteroids have a clearly defined role in the management of acute asthma in the hospital setting. Therefore, it is reasonable for clinicians to recommend PIOCS when (i) the child has a history of severe acute asthma; and (ii) the parents are able to assess asthma status. However, widespread use of PIOCS 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，是儿童急需就医的最常见原因之一。本系统评价的目的是评估家长自行给予口服糖皮质激素（PIOCS）治疗儿童间歇性喘息疾病的益处和有害影响。
检索了Cochrane Airways Group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数据库。纳入的研究仅为针对1至18岁患有间歇性喘息疾病患者的随机临床试验。
从572条原始文献中，共纳入两项随机临床试验（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。两项试验均未发现证据表明PIOCS在住院、非计划医疗复诊、症状评分或使用支气管扩张剂方面有获益。
目前可用的证据有限，关于PIOCS治疗儿童间歇性喘息疾病的获益尚无定论。口服糖皮质激素在医院环境中治疗急性哮喘有明确的作用。因此，当（i）儿童有严重急性哮喘病史；以及（ii）家长能够评估哮喘状态时，临床医生推荐PIOCS是合理的。然而，在益处和危害能进一步明确之前，不建议广泛使用PIOCS。
