Abaya Ruth, Jones Laura, Zorc Joseph J
Pediatr Emerg Care. 2018 Jan;34(1):53-58. doi: 10.1097/PEC.0000000000001371.
Systemic corticosteroids are recommended in clinical practice guidelines for the treatment of acute asthma exacerbation based on evidence demonstrating reduced hospitalizations and improved outcomes after administration in the emergency department. Although prednisone and related oral preparations have been recommended previously, researchers have assessed dexamethasone as an alternative based on its longer biologic half-life and improved palatability. Systematic reviews of multiple small trials and 2 larger trials have found no difference in revisits to the emergency department compared to prednisone for dexamethasone given either as an intramuscular injection or orally. Studies of oral administration have found reduced emesis for dexamethasone compared to prednisone both in the emergency department and for a second oral dose, typically given 24 to 48 hours later. Studies assessing a single dose of dexamethasone have found equivalent improvement at follow-up but with some evidence of increased symptoms and increased need for additional corticosteroids compared to multiple doses of prednisone. Future research could further assess dexamethasone dose, formulation, and frequency and measure other related adverse effects such as behavior change. Consideration of baseline differences within the heterogeneous population of children requiring acute care for asthma may also guide the design of an optimal dexamethasone regimen.
基于在急诊科给药后住院率降低和预后改善的证据，临床实践指南推荐全身用糖皮质激素治疗急性哮喘加重。尽管此前推荐使用泼尼松及相关口服制剂，但研究人员基于地塞米松更长的生物半衰期和更好的适口性，评估其作为替代药物。对多个小型试验和2个大型试验的系统评价发现，与泼尼松相比，肌肉注射或口服地塞米松后，急诊复诊率并无差异。口服给药的研究发现，在地塞米松在急诊科给药时以及通常在24至48小时后给予的第二剂口服时，与泼尼松相比，呕吐减少。评估单剂量地塞米松的研究发现，随访时改善情况相当，但与多剂量泼尼松相比，有一些症状加重和额外糖皮质激素需求增加的证据。未来的研究可以进一步评估地塞米松的剂量、剂型和频率，并测量其他相关不良反应，如行为改变。考虑到需要急性哮喘护理的异质儿童群体中的基线差异，也可能指导最佳地塞米松治疗方案的设计。
