Schultz André, Brand Paul L P
Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
J Paediatr Child Health. 2012 Feb;48(2):E73-8. doi: 10.1111/j.1440-1754.2011.02123.x. Epub 2011 Jun 17.
Wheeze in childhood may comprise different underlying diseases. Disease-specific treatment could potentially improve treatment efficacy. Various attempts have been made to differentiate between pre-school wheeze phenotypes. In this review, the results of clinical trials evaluating treatment of pre-school wheeze are discussed, with specific emphasis on the characteristics and phenotype of the study populations. Evidence suggests that systemic corticosteroids are not beneficial for the treatment of mild-to-moderate exacerbations of pre-school wheeze, irrespective of phenotype. The use of high-dose intermittent inhaled corticosteroid treatment cannot be recommended because of unacceptable side effects. Treatment with regular inhaled corticosteroids and leukotriene antagonists offer modest benefit, but neither treatment reduces hospitalisation rates. There is currently some evidence for a phenotype-specific effect of treatment. Phenotype-directed treatment of pre-school wheeze is currently limited by our ability to accurately differentiate between clinically useful phenotypes.
儿童喘息可能由不同的潜在疾病引起。针对特定疾病的治疗可能会提高治疗效果。人们已进行了各种尝试来区分学龄前喘息的不同表型。在这篇综述中，我们讨论了评估学龄前喘息治疗的临床试验结果，特别强调了研究人群的特征和表型。有证据表明，无论表型如何，全身用糖皮质激素对治疗学龄前喘息的轻至中度加重并无益处。由于存在不可接受的副作用，不建议使用高剂量间歇性吸入糖皮质激素治疗。规律吸入糖皮质激素和白三烯拮抗剂治疗有一定益处，但两种治疗均不能降低住院率。目前有一些证据表明治疗存在表型特异性效应。目前，学龄前喘息的表型导向治疗受到我们准确区分临床有用表型能力的限制。
