Chapman K R, Verbeek P R, White J G, Rebuck A S
Asthma Centre, Toronto Hospital, ON, Canada.
N Engl J Med. 1991 Mar 21;324(12):788-94. doi: 10.1056/NEJM199103213241202.
Relapse after the treatment of acute asthma in the emergency room is common (occurring in 25 to 30 percent of cases) and is not accurately predicted by any available measurements. We studied the usefulness of prednisone in reducing this high rate of relapse.
One hundred twenty-two patients treated in the emergency room for acute exacerbations of asthma were assigned in a randomized, double-blind fashion to receive at discharge either prednisone for eight days (the dose being tapered from 40 to 0 mg per day) or matching placebo. Ninety-three were subsequently discharged from the emergency room and participated in the trial. On days 1, 7, and 14 after discharge, the patients were assessed during home visits with spirometry and diary-card review; they were contacted by telephone on day 21. Relapse was defined as an unscheduled medical visit occasioned by the patient's perceived need for further asthma treatment.
The overall risk of relapse was significantly lower in the prednisone group (P less than 0.05), with a significantly reduced rate of relapse during the first 10 days of follow-up (3 of 48, as compared with 11 of 45 in the placebo group; P less than 0.05). Thereafter (days 11 through 21), there was no further significant difference in relapse rates between treatment groups (five in the prednisone group and six in the placebo group). During the first week after discharge, patients receiving prednisone reported significantly lower mean (+/- SD) daily symptom scores for shortness of breath (1.4 +/- 0.4 vs. 2.5 +/- 0.4, P less than 0.01) and less frequent use of an inhaled bronchodilator (5.2 +/- 0.5 vs. 6.9 +/- 0.2 puffs per day, P less than 0.05) than patients receiving placebo. Subsequently, symptom scores and bronchodilator use were similar in the two groups.
A short course of prednisone reduced early relapse rates after the treatment of acute asthma in the emergency room, an effect limited to the period of steroid administration.
急诊室中急性哮喘治疗后的复发很常见（发生率为25%至30%），且任何现有测量方法都无法准确预测复发情况。我们研究了泼尼松在降低这种高复发率方面的作用。
122例因哮喘急性加重在急诊室接受治疗的患者，以随机、双盲方式分配，出院时分别接受为期8天的泼尼松治疗（剂量从每日40毫克逐渐减至0毫克）或匹配的安慰剂。随后93例患者从急诊室出院并参与试验。出院后第1、7和14天，通过家庭访视时的肺活量测定和查看日记卡对患者进行评估；在第21天通过电话联系他们。复发定义为由患者认为需要进一步哮喘治疗而引发的非计划就诊。
泼尼松组的总体复发风险显著较低（P<0.05），在随访的前10天内复发率显著降低（48例中有3例，而安慰剂组45例中有11例；P<0.05）。此后（第11至21天），治疗组之间的复发率没有进一步显著差异（泼尼松组5例，安慰剂组6例）。出院后的第一周内，接受泼尼松治疗的患者报告的每日平均（±标准差）呼吸急促症状评分显著较低（1.4±0.4 vs. 2.5±0.4，P<0.01），且使用吸入性支气管扩张剂的频率低于接受安慰剂的患者（每天5.2±0.5次 vs. 6.9±0.2次，P<0.05）。随后，两组的症状评分和支气管扩张剂使用情况相似。
短期使用泼尼松可降低急诊室急性哮喘治疗后的早期复发率，这种效果仅限于类固醇给药期间。
