Tal A, Levy N, Bearman J E
Pediatric Division, Soroka Medical Center, Beer Sheva, Israel.
Pediatrics. 1990 Sep;86(3):350-6.
A controlled double-blind trial was carried out to assess the effect of the early introduction of combined corticosteroid and beta-adrenergic drugs for the treatment of acute asthma in infants and toddlers. Seventy-four emergency room patients (aged 7 to 54 months) who were treated for acute asthma were studied. Treatment included, in addition to salbutamol inhalations, a single dose of intramuscular methylprednisolone (4 mg/kg) or normal saline as placebo. The patients were reevaluated 3 hours after initiation of treatment. At that time, patients were either admitted or discharged based on a clinical decision. Only 8 (20%) of 39 patients treated with steroids were admitted, compared with 15 (43%) of 35 in the placebo group (P less than .05). Sequential analysis of 33 pairs, matched by age and severity of symptoms, revealed statistically significant reduced admission rates in patients treated with steroids. In the younger patients (6 to 24 months), admission rate was significantly lower for those treated with steroids (18%) as compared with those treated without steroids (50%) (P less than .05). In the older group (24 to 54 months), the trend was similar but not statistically significant: 23% vs 31% in the steroid and placebo groups, respectively. These data indicate that corticosteroid treatment combined with an adrenergic agent, given early during an acute asthmatic episode, significantly reduces the hospital admission rate of infants and toddlers.
进行了一项对照双盲试验，以评估早期联合使用皮质类固醇和β-肾上腺素能药物治疗婴幼儿急性哮喘的效果。研究了74名因急性哮喘接受治疗的急诊室患者（年龄在7至54个月之间）。治疗除沙丁胺醇吸入外，还包括单剂量肌肉注射甲泼尼龙（4mg/kg）或生理盐水作为安慰剂。治疗开始3小时后对患者进行重新评估。此时，根据临床决定对患者进行入院或出院处理。接受类固醇治疗的39名患者中只有8名（20%）入院，而安慰剂组35名患者中有15名（43%）入院（P<0.05）。对按年龄和症状严重程度匹配的33对患者进行序贯分析，结果显示接受类固醇治疗的患者入院率有统计学意义的降低。在较年轻的患者（6至24个月）中，接受类固醇治疗的患者入院率（18%）明显低于未接受类固醇治疗的患者（50%）（P<0.05）。在较年长的组（24至54个月）中，趋势相似但无统计学意义：类固醇组和安慰剂组分别为23%和31%。这些数据表明，在急性哮喘发作早期联合使用皮质类固醇治疗和肾上腺素能药物可显著降低婴幼儿的住院率。
