Scadding Glenis
Royal National Throat Nose & Ear Hospital, London, UK.
Paediatr Drugs. 2008;10(3):151-62. doi: 10.2165/00148581-200810030-00004.
Nasal congestion is such a frequent and multifactorial occurrence in young children that parents and medical caregivers often overlook the need for medical intervention. However, children with congestion can suffer quality-of-life detriments resulting from sleep disturbance, learning impairment, and fatigue. Congestion also impairs the normal nasal breathing that is physiologically important for the efficient cleaning and conditioning of inspired air. Further, the most common cause of congestion, allergic rhinitis, is considered a potential risk factor for asthma. Published guidelines on the treatment of allergic rhinitis agree that management strategies in children should follow the same principles as in adults, while recognizing the need for dosage adjustments and being aware of unique safety issues. Intranasal corticosteroids, with robust effects in reducing congestion and good tolerability, remain a treatment of choice. Despite lingering concerns about the potential for growth suppression with these drugs, clinical evidence suggests a very low risk at prescribed dosages, especially with compounds that have a low systemic bioavailability. Oral antihistamines are commonly cited as first-line options for allergic rhinitis, although their effect on nasal congestion is relatively modest. First-generation antihistamines should not be administered to children because of their sedative properties, which can worsen learning problems associated with allergic rhinitis. Second-generation oral antihistamines are preferred, although this class is not completely devoid of adverse effects. Other treatments, such as a nasal antihistamine, decongestants, and immunotherapy, present varying levels of safety and tolerability issues in children.
鼻充血在幼儿中是一种常见且多因素导致的情况，以至于家长和医护人员常常忽视进行医学干预的必要性。然而，患有鼻充血的儿童可能会因睡眠障碍、学习障碍和疲劳而导致生活质量下降。鼻充血还会损害正常的鼻腔呼吸，而鼻腔呼吸对于有效清洁和调节吸入空气在生理上是很重要的。此外，鼻充血最常见的原因——变应性鼻炎，被认为是哮喘的一个潜在危险因素。已发表的变应性鼻炎治疗指南一致认为，儿童的治疗策略应遵循与成人相同的原则，同时要认识到需要调整剂量并注意独特的安全问题。鼻用糖皮质激素在减轻鼻充血方面效果显著且耐受性良好，仍然是一种首选治疗方法。尽管人们一直担心这些药物可能会抑制生长，但临床证据表明，按照规定剂量使用时风险非常低，尤其是对于全身生物利用度低的化合物。口服抗组胺药通常被列为变应性鼻炎的一线治疗选择，尽管它们对鼻充血的作用相对较小。由于第一代抗组胺药具有镇静作用，会加重与变应性鼻炎相关的学习问题，因此不应给儿童使用。第二代口服抗组胺药是首选，尽管这类药物也并非完全没有不良反应。其他治疗方法，如鼻用抗组胺药、减充血剂和免疫疗法，在儿童中存在不同程度的安全性和耐受性问题。
