儿童急性呼吸道疾病中皮质类固醇效用的最新进展
Update on the utility of corticosteroids in acute pediatric respiratory disorders.
作者信息
Beigelman Avraham, Chipps Bradley E, Bacharier Leonard B
机构信息
Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Washington University School of Medicine and St. Louis Children's Hospital, St. Louis, Missouri, USA.
出版信息
Allergy Asthma Proc. 2015 Sep-Oct;36(5):332-8. doi: 10.2500/aap.2015.36.3865.
BACKGROUND
Corticosteroids, delivered systemically and by inhalation, are widely used for the treatment of multiple acute respiratory illnesses in children. However, the level of evidence to support the utility of this therapy varies between these different acute respiratory illnesses.
OBJECTIVE
To summarize the evidence regarding the utility of corticosteroids in the management of common acute pediatric respiratory conditions and to highlights the controversies regarding their use.
METHODS
Literature search of manuscripts describing the evidence regarding the efficacy of corticosteroids (systemic and inhaled) in the management of: acute asthma exacerbation among school age children, acute episodic wheeze among preschool children, viral croup, and acute viral bronchiolitis.
RESULTS
Current evidence indicates that systemic corticosteroids provide benefits for the treatment of acute asthma exacerbations in school age children, mainly in the acute care setting. In addition, high dose inhaled corticosteroid therapy administered in the Emergency Department appears to have comparable effect for the prevention of asthma-related hospital admission as systemic corticosteroids in this age group. In contrast, most available studies have not shown benefit for systemic corticosteroids during acute wheezing episodes in preschool children. Systemic corticosteroids decrease symptoms and the rate of hospital admissions in patients with severe croup; however, corticosteroids have no role in the treatment of acute bronchiolitis and their use in this condition should be discouraged.
CONCLUSION
Corticosteroids treatment response varies between the acute respiratory illnesses presented in this review. Future research should aim to fill the current gaps-of-knowledge regarding the utility this intervention such as the identification of specific wheezing phenotypes among preschool children which might benefit from systemic corticosteroids as a treatment for acute viral wheeze.
背景
全身应用及吸入用糖皮质激素广泛用于治疗儿童多种急性呼吸道疾病。然而，支持这种治疗方法有效性的证据水平在这些不同的急性呼吸道疾病中有所不同。
目的
总结糖皮质激素在常见儿童急性呼吸道疾病管理中的有效性证据，并突出其使用方面的争议。
方法
检索描述糖皮质激素（全身应用和吸入用）在以下疾病管理中的有效性证据的文献：学龄儿童急性哮喘发作、学龄前儿童急性间歇性喘息、病毒性喉炎和急性病毒性细支气管炎。
结果
目前的证据表明，全身应用糖皮质激素对治疗学龄儿童急性哮喘发作有益，主要在急性护理环境中。此外，在急诊科给予高剂量吸入糖皮质激素治疗预防哮喘相关住院的效果，在该年龄组中似乎与全身应用糖皮质激素相当。相比之下，大多数现有研究未显示全身应用糖皮质激素对学龄前儿童急性喘息发作有益。全身应用糖皮质激素可减轻重症喉炎患者的症状并降低住院率；然而，糖皮质激素对急性细支气管炎的治疗无效，不应在这种情况下使用。
结论
糖皮质激素的治疗反应在本综述中呈现的急性呼吸道疾病之间有所不同。未来的研究应旨在填补当前关于这种干预措施有效性的知识空白，例如确定学龄前儿童中可能受益于全身应用糖皮质激素治疗急性病毒性喘息的特定喘息表型。
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