Scarfone R J, Loiselle J M, Wiley J F, Decker J M, Henretig F M, Joffe M D
Department of Pediatrics, Temple University School of Medicine, St Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.
Ann Emerg Med. 1995 Oct;26(4):480-6. doi: 10.1016/s0196-0644(95)70118-4.
To compare nebulized dexamethasone with oral prednisone in the treatment of children with asthma.
A randomized, double-blind, double-placebo study.
An urban pediatric emergency department.
Patients aged 1 to 17 years with acute asthma.
Patients with moderate asthma exacerbation received frequent aerosolized albuterol and either 1.5 mg/kg of nebulized dexamethasone or 2 mg/kg of oral prednisone.
A total of 111 children was evaluated; 21% of those treated with dexamethasone required hospitalization, compared with 31% of those treated with prednisone (P = .26). A significantly greater proportion of dexamethasone-treated children were discharged home within 2 hours (23% versus 7%, P = .02). In the dexamethasone group, 8% who received the drug by mouthpiece were hospitalized compared with 33% who received it by face mask (P = .06). Fewer children treated with dexamethasone vomited (0% versus 15%, P = .001) and fewer relapsed within 48 hours of ED discharge (0% versus 16%, P = .008).
Nebulized dexamethasone was as effective as oral prednisone in the ED treatment of moderately ill children with acute asthma and was associated with more rapid clinical improvement, more reliable drug delivery, and fewer relapses.
比较雾化地塞米松与口服泼尼松治疗儿童哮喘的效果。
一项随机、双盲、双安慰剂研究。
城市儿科急诊科。
1至17岁的急性哮喘患者。
中度哮喘加重的患者接受频繁雾化沙丁胺醇治疗，并随机分为两组，一组接受1.5mg/kg雾化地塞米松治疗，另一组接受2mg/kg口服泼尼松治疗。
共评估了111名儿童；接受地塞米松治疗的患者中有21%需要住院治疗，而接受泼尼松治疗的患者中这一比例为31%（P = 0.26）。接受地塞米松治疗的儿童中有显著更高比例（23%对7%，P = 0.02）在2小时内出院回家。在地塞米松组中，通过口含器接受药物治疗的患者中有8%住院，而通过面罩接受药物治疗的患者中这一比例为33%（P = 0.06）。接受地塞米松治疗的儿童呕吐较少（0%对15%，P = 0.001），且在急诊出院后48小时内复发较少（0%对16%，P = 0.008）。
在急诊科治疗中度急性哮喘患儿时，雾化地塞米松与口服泼尼松效果相当，且临床改善更快、药物递送更可靠、复发更少。
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