预防性吸入皮质类固醇治疗复发性喉炎。

Prophylactic inhaled corticosteroids for the management of recurrent croup.

机构信息

Dr. Sowa is Currently with the Riley Hospital for Children, Department of Otolaryngology, Indiana University, United States.

University of Colorado, Children's Hospital Colorado, Department of Pulmonology and Sleep Medicine, United States.

出版信息

Int J Pediatr Otorhinolaryngol. 2023 Jul;170:111600. doi: 10.1016/j.ijporl.2023.111600. Epub 2023 May 9.

DOI:10.1016/j.ijporl.2023.111600

PMID:37201337

Abstract

OBJECTIVES

Croup is characterized by a barky cough, inspiratory stridor, hoarseness and varying degrees of respiratory distress. Acute croup episodes are often treated with oral, inhaled, or intravenous corticosteroids. Recurrent croup, defined as more than 2-3 episodes of acute croup in the same patient, can mimic asthma. We hypothesized that inhaled corticosteroids (ICS) given at the first sign of a respiratory viral prodrome can be a safe treatment to reduce the frequency of recurrent croup episodes in children without fixed airway lesions.

METHODS

A retrospective chart review of patients being treated over an 18-month period was performed at a large tertiary care pediatric hospital following Institutional Review Board (IRB) approval. Patients under 21 years old referred to Pediatric Pulmonology, Otolaryngology, or Gastroenterology for recurrent croup were analyzed for their demographics, medical history, evaluation, treatment and clinical improvement. A Fisher's two-tailed exact test was used to compare the number of croup episodes before and after interventions.

RESULTS

124 patients were included in our analysis: 87 male and 34 female with a mean age of 54 months. Of these, 78 had >5 episodes of croup, 45 had 3-5, and 3 had 2 episodes prior to their first visit for recurrent croup. Operative direct laryngoscopy/bronchoscopy was performed in 35 patients (27.8%), with 60% showing a normal exam without fixed lesions. Ninety-two patients (74.2%) were treated with ICS, 24 were lost to follow up. Of the remaining 68 treated patients, 59 (86.7%) saw improvement with reduced severity and overall number of episodes of croup. Additionally, patients with >5 episodes of croup (47) as compared to <5 (12) were more likely to improve with ICS, (p = 0.003). There were no adverse reactions reported with ICS treatment.

CONCLUSION

The novel initiation of ICS at the earliest sign of a viral upper respiratory infection shows promise as a safe preventative treatment to mitigate the frequency of recurrent croup episodes.

摘要

目的

哮吼的特征是犬吠样咳嗽、吸气性喘鸣、声音嘶哑和不同程度的呼吸窘迫。急性哮吼发作常采用口服、吸入或静脉用皮质类固醇治疗。反复发作性哮吼（定义为同一患者出现 2-3 次以上急性哮吼发作）可类似哮喘。我们假设，在呼吸道病毒前驱症状出现时给予吸入皮质类固醇（ICS）可以作为一种安全的治疗方法，减少无固定气道病变的儿童反复发作性哮吼发作的频率。

方法

在获得机构审查委员会（IRB）批准后，我们对一家大型三级儿童保健医院在 18 个月期间接受治疗的患者进行了回顾性图表审查。因反复发作性哮吼而转至儿科肺病、耳鼻喉科或胃肠病科的 21 岁以下患者，对其人口统计学、病史、评估、治疗和临床改善情况进行了分析。使用 Fisher 双侧精确检验比较干预前后哮吼发作次数。

结果

我们的分析纳入了 124 例患者：男性 87 例，女性 34 例，平均年龄为 54 个月。其中，78 例有>5 次哮吼发作，45 例有 3-5 次，3 例有 2 次发作，随后因反复发作性哮吼首次就诊。35 例（27.8%）患者进行了手术直接喉镜/支气管镜检查，其中 60%检查结果正常，无固定病变。92 例（74.2%）患者接受了 ICS 治疗，24 例患者失访。在其余 68 例接受治疗的患者中，59 例（86.7%）的病情改善，哮吼发作的严重程度和总次数减少。此外，与 ICS 治疗效果更好的>5 次哮吼发作患者（47 例）相比，<5 次哮吼发作患者（12 例）（p=0.003）。ICS 治疗未报告不良反应。