家长为学龄期儿童启动急性哮喘的泼尼松龙治疗：随机对照交叉试验。
Parent initiated prednisolone for acute asthma in children of school age: randomised controlled crossover trial.
机构信息
Geelong Hospital, Barwon Health, Geelong 3220, Australia.
出版信息
BMJ. 2010 Mar 1;340:c843. doi: 10.1136/bmj.c843.
OBJECTIVE
To evaluate the efficacy of a short course of parent initiated oral prednisolone for acute asthma in children of school age.
DESIGN
Double blind, randomised, placebo controlled, crossover trial in which episodes of asthma, rather than participants, were randomised to treatment.
SETTING
The Barwon region of Victoria, Australia.
PARTICIPANTS
Children aged 5-12 years with a history of recurrent episodes of acute asthma.
INTERVENTION
A short course of parent initiated treatment with prednisolone (1 mg/kg a day) or placebo.
MAIN OUTCOME MEASURES
The primary outcome measure was the mean daytime symptom score over seven days. Secondary outcome measures were mean night time symptom score over seven days, use of health resources, and school absenteeism.
RESULTS
230 children were enrolled in the study. Over a three year period, 131 (57%) of the participants contributed a total of 308 episodes of asthma that required parent initiated treatment: 155 episodes were treated with parent initiated prednisolone and 153 with placebo. The mean daytime symptom score was 15% lower in episodes treated with prednisolone than in those treated with placebo (geometric mean ratio 0.85, 95% CI 0.74 to 0.98; P=0.023). Treatment with prednisolone was also associated with a 16% reduction in the night time symptom score (geometric mean ratio 0.84, 95% CI 0.70 to 1.00; P=0.050), a reduced risk of health resource use (odds ratio 0.54, 95% CI 0.34 to 0.86; P=0.010), and reduced school absenteeism (mean difference -0.4 days, 95% CI -0.8 to 0.0 days; P=0.045).
CONCLUSION
A short course of oral prednisolone initiated by parents when their child experiences an episode of acute asthma may reduce asthma symptoms, health resource use, and school absenteeism. However, the modest benefits of this strategy must be balanced against potential side effects of repeated short courses of an oral corticosteroid.
TRIAL REGISTRATION
ISRCTN 26232583.
目的
评估由家长发起的短期口服泼尼松龙治疗学龄儿童急性哮喘的疗效。
设计
双盲、随机、安慰剂对照、交叉试验，其中哮喘发作而非参与者被随机分配至治疗组。
地点
澳大利亚维多利亚州的 Barwon 地区。
参与者
有反复发作急性哮喘史的 5-12 岁儿童。
干预措施
家长发起的短期治疗，给予泼尼松龙（1mg/kg/天）或安慰剂。
主要观察指标
主要结局指标为 7 天内日间症状评分的平均值。次要结局指标为 7 天内夜间症状评分的平均值、卫生资源的使用情况和缺课天数。
结果
共有 230 名儿童参与了这项研究。在 3 年期间，131 名（57%）参与者共发生了 308 次需要家长发起治疗的哮喘发作：155 次发作接受了家长发起的泼尼松龙治疗，153 次发作接受了安慰剂治疗。与安慰剂相比，接受泼尼松龙治疗的发作日间症状评分降低了 15%（几何均数比 0.85，95%CI 0.74 至 0.98；P=0.023）。泼尼松龙治疗还与夜间症状评分降低 16%相关（几何均数比 0.84，95%CI 0.70 至 1.00；P=0.050）、卫生资源使用风险降低（比值比 0.54，95%CI 0.34 至 0.86；P=0.010）以及缺课天数减少（平均差异-0.4 天，95%CI -0.8 至 0.0 天；P=0.045）。
结论
当儿童经历急性哮喘发作时，家长发起的短期口服泼尼松龙治疗可能会减轻哮喘症状、卫生资源的使用和缺课天数。然而，这种策略的适度益处必须与重复短期口服皮质类固醇的潜在副作用相平衡。
试验注册
ISRCTN26232583。
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