Departments of Pediatrics, and.
Pediatrics. 2014 Mar;133(3):493-9. doi: 10.1542/peds.2013-2273. Epub 2014 Feb 10.
Dexamethasone has been proposed as an equivalent therapy to prednisone/prednisolone for acute asthma exacerbations in pediatric patients. Although multiple small trials exist, clear consensus data are lacking. This systematic review and meta-analysis aimed to determine whether intramuscular or oral dexamethasone is equivalent or superior to a 5-day course of oral prednisone or prednisolone. The primary outcome of interest was return visits or hospital readmissions.
A search of PubMed (Medline) through October 19, 2013, by using the keywords dexamethasone or decadron and asthma or status asthmaticus identified potential studies. Six randomized controlled trials in the emergency department of children ≤18 years of age comparing dexamethasone with prednisone/prednisolone for the treatment of acute asthma exacerbations were included. Data were abstracted by 4 authors and verified by a second author. Two reviewers evaluated study quality independently and interrater agreement was assessed.
There was no difference in relative risk (RR) of relapse between the 2 groups at any time point (5 days RR 0.90, 95% confidence interval [CI] 0.46-1.78, Q = 1.86, df = 3, I2 = 0.0%, 10-14 days RR 1.14, 95% CI 0.77-1.67, Q = 0.84, df = 2, I2 = 0.0%, or 30 days RR 1.20, 95% CI 0.03-56.93). Patients who received dexamethasone were less likely to experience vomiting in either the emergency department (RR 0.29, 95% CI 0.12-0.69, Q = 3.78, df = 3, I2 = 20.7%) or at home (RR 0.32, 95% CI 0.14-0.74, Q = 2.09, df = 2, I2 = 4.2%).
Practitioners should consider single or 2-dose regimens of dexamethasone as a viable alternative to a 5-day course of prednisone/prednisolone.
地塞米松已被提议作为儿科患者急性哮喘发作的等效治疗药物，替代泼尼松/强的松。尽管有多项小型试验，但缺乏明确的共识数据。本系统评价和荟萃分析旨在确定肌内或口服地塞米松是否与 5 天疗程的口服泼尼松或强的松等效或更优。主要观察指标为复诊或住院再入院。
通过使用关键词地塞米松或地塞米松和哮喘或哮喘状态，于 2013 年 10 月 19 日之前在 PubMed（医学文献在线数据库）进行搜索，以确定潜在的研究。纳入了 6 项比较儿童急诊科中地塞米松与泼尼松/强的松治疗急性哮喘发作的随机对照试验，纳入患者年龄均≤18 岁。由 4 位作者提取数据，另由第 2 位作者进行核实。2 位评审员独立评估研究质量，并评估了两者间的一致性。
两组在任何时间点的复发相对风险（RR）均无差异（5 天 RR 0.90，95%置信区间[CI]0.46-1.78，Q = 1.86，df = 3，I2 = 0.0%，10-14 天 RR 1.14，95%CI 0.77-1.67，Q = 0.84，df = 2，I2 = 0.0%，或 30 天 RR 1.20，95%CI 0.03-56.93）。接受地塞米松治疗的患者，在急诊科（RR 0.29，95%CI 0.12-0.69，Q = 3.78，df = 3，I2 = 20.7%）或在家中（RR 0.32，95%CI 0.14-0.74，Q = 2.09，df = 2，I2 = 4.2%）更不易出现呕吐。
从业者应考虑地塞米松单次或 2 剂量方案作为替代泼尼松/强的松 5 天疗程的可行选择。
