Klig J E, Hodge D, Rutherford M W
Department of Pediatrics (Pediatric Emergency Department), Yale University School of Medicine, New Haven, CT, USA.
J Asthma. 1997;34(5):419-25. doi: 10.3109/02770909709055384.
Systemic corticosteroid therapy is an established adjunct to beta-adrenergic medications in acute exacerbations of asthma. To date, no study has defined the role of long-acting intramuscular preparations of corticosteroids in pediatric patients with asthma. A pilot study was conducted to prospectively compare symptomatic improvement following a single injection of intramuscular dexamethasone (IMD) to a 3-day regimen of oral prednisone (OP) for children with mild to moderate wheezing episodes that are responsive to nebulized medications in the Pediatric Emergency Department (PED). The following children presenting with acute exacerbations of asthma to the PED were eligible for enrollment: age 3-16 years; more than two prior wheezing episodes; mild to moderate wheezing; and oxygen saturation 95% or more in room air. The study patients were randomly assigned to receive either IMD (n = 21) or OP (n = 21) in addition to a standardized treatment regimen of nebulized albuterol. All of the children were clinically rated for wheezing severity by the Pulmonary Index (PI) score at regular intervals during the study. Discharge home was based on clinical improvement during treatment in the PED; patients who were admitted to the hospital were removed from the study. Follow-up was conducted the fifth day after discharge from the ED either by clinic visit or by telephone. Patients were assessed for symptomatic improvement and relapse or clinical deterioration during the study period by a clinician blinded to group assignment. Forty-two children participated in this pilot study. There were no significant differences between the IMD and OP groups for gender or age. Mean ages were: 82 months (SD 46 months), IMD group; 63 months (SD 36 months), OP group. Clinical progress (based on PI) with treatment in the PED was the same in both groups: pretreatment median, PI = 6; PED discharge median, PI = 2. None of the study patients were hospitalized during the follow-up period, and all reported symptomatic improvement since initial treatment. The data of this pilot study suggest that IMD may be a feasible alternative to OP for treatment of acute wheezing episodes in children with asthma. IMD provides sufficient treatment to prevent clinical deterioration within 5 days after initial therapy for mild to moderate pediatric exacerbations of asthma that are responsive to nebulized medications.
全身用皮质类固醇疗法是哮喘急性加重期β-肾上腺素能药物的既定辅助治疗方法。迄今为止，尚无研究明确长效皮质类固醇肌肉注射制剂在儿科哮喘患者中的作用。开展了一项前瞻性试点研究，比较单次肌肉注射地塞米松（IMD）与口服泼尼松（OP）3天方案对儿科急诊科（PED）中对雾化药物有反应的轻至中度喘息发作儿童的症状改善情况。以下患有哮喘急性加重期并前往PED就诊的儿童符合入组条件：年龄3至16岁；既往有两次以上喘息发作；轻至中度喘息；室内空气中氧饱和度95%或更高。研究患者在接受雾化沙丁胺醇标准化治疗方案的基础上，随机分配接受IMD（n = 21）或OP（n = 21）治疗。在研究期间，所有儿童定期通过肺部指数（PI）评分对喘息严重程度进行临床评估。根据PED治疗期间的临床改善情况决定出院；入院的患者被排除在研究之外。出院后第五天通过门诊就诊或电话进行随访。由对分组不知情的临床医生评估患者在研究期间的症状改善情况以及复发或临床恶化情况。42名儿童参与了这项试点研究。IMD组和OP组在性别或年龄方面无显著差异。平均年龄分别为：IMD组82个月（标准差46个月）；OP组63个月（标准差36个月）。两组在PED的治疗临床进展（基于PI）相同：治疗前中位数，PI = 6；PED出院时中位数，PI = 2。在随访期间，没有研究患者住院，所有患者均报告自初始治疗后症状有所改善。这项试点研究的数据表明，对于治疗哮喘儿童的急性喘息发作，IMD可能是OP的一种可行替代方案。对于对雾化药物有反应的轻至中度儿科哮喘加重期，IMD提供了足够的治疗以防止初始治疗后5天内的临床恶化。
