Intervention Review

Inhaled steroids for episodic viral wheeze of childhood

  1. Michael C McKean1,*,
  2. Francine Ducharme2

Editorial Group: Cochrane Airways Group

Published Online: 21 JAN 2009

Assessed as up-to-date: 25 OCT 1999

DOI: 10.1002/14651858.CD001107

Database Title

Additional Information

How to Cite

McKean MC, Ducharme F. Inhaled steroids for episodic viral wheeze of childhood. Cochrane Database of Systematic Reviews 2000, Issue 1. Art. No.: CD001107. DOI: 10.1002/14651858.CD001107.

Author Information

  1. 1

    Newcastle upon Tyne NHS Trust, Paediatrics, Newcastle upon Tyne, Tyne and Wear, UK

  2. 2

    CHU Sainte-Justine, Direction de la Recherche/ Research Centre, Montreal, Québec, Canada

*Michael C McKean, Paediatrics, Newcastle upon Tyne NHS Trust, 3 rd Floor, Doctors Residence, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, Tyne and Wear, NE1 4LP, UK. m.c.mckean@ncl.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 21 JAN 2009

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Recurrent episodic wheeze in association with viral upper respiratory tract infection (URTI) is a specific clinical illness distinct from persistent atopic asthma.

Objectives

The objective of this review was to identify whether corticosteroid treatment, given episodically or daily, is beneficial to children with viral episodic wheeze.

Search methods

We searched the Cochrane Airways Group trials register and reference lists of articles.

Selection criteria

Randomised controlled trials (RCTs) of corticosteroid treatment versus placebo in children under 17 years of age who suffer from 'episodic viral wheeze', which is defined by wheeze in association with coryzal symptoms with minimal or no intercurrent lower respiratory tract symptoms.

Data collection and analysis

Trial quality was assessed independently by two reviewers. Study authors were contacted for missing information. Studies were categorised according to whether treatment was given episodically or daily (maintenance). The primary outcome was episodes requiring oral corticosteroids. Secondary outcomes addressed episode severity, frequency and duration and parental treatment preference.

Main results

Five randomised controlled trials in children with a history of mild episodic viral wheeze were identified. Most of the children had previously required no or infrequent oral corticosteroids and had very infrequent hospital admissions. There were three studies of preschool children given episodic high dose inhaled corticosteroid (1.6 - 2.25 mg per day), two using a crossover and one a parallel design. The two studies of maintenance corticosteroid (400 micrograms per day) were parallel in design, one of pre-school children the other of children aged 7 -9 years. Results from the two cross-over studies of episodic high dose inhaled corticosteroids showed a reduced requirement for oral corticosteroids (Relative risk (RR)=0.53, 95% CI: 0.27, 1.04). In these 2 double blind studies, this treatment was preferred by the children's parents over placebo (RR=0.64, 95% CI: 0.48,0.87). Maintenance low dose inhaled corticosteroids did not show any clear reduction over placebo in the proportion of episodes requiring oral corticosteroids (N=2 trials, RR=0.82, 95%CI: 0.23,2.90) or in those requiring hospital admission (N=1 trial, RR=0.21, 95% CI: 0.01,4.11).

Authors' conclusions

Episodic high dose inhaled corticosteroids provide a partially effective strategy for the treatment of mild episodic viral wheeze of childhood. There is no current evidence to favour maintenance low dose inhaled corticosteroids in the prevention and management of episodic mild viral induced wheeze.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Inhaled steroids for episodic viral wheeze of childhood

A wheeze that is recurrent and caused by a viral upper respiratory tract infection (URTI) is different to asthma. Episodic recurrent wheezing happens in children who have no symptoms in between episodes and is different to wheezing that is persistent. Corticosteroids are used to relieve a wheeze caused by a viral infection. This review of trials found high dose inhaled corticosteroids help treat mild episodic viral wheeze of childhood. There is no evidence to support the use of maintenance low dose inhaled corticosteroids to prevent or manage episodic mild wheeze caused by a virus. More research is needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

吸入性類固醇對於兒童時期陣發性病毒哮鳴之療效

伴隨病毒性上呼吸道感染的反覆性陣發性哮鳴,臨床上是不同於持續性異位性氣喘的一種疾病.

目標

本文的主要目的在於評估陣發性或每日給予類固醇治療,對於陣發性病毒哮鳴的兒童是否有所助益.

搜尋策略

我們搜尋考科藍登錄呼吸道群組登記的試驗(Cochrane Airways Group trials register) 和文獻的參考資料.

選擇標準

隨機對照試驗(Randomised controlled trials) 選取17歲以下有鼻炎症狀,但並未併發下呼吸道症狀的陣發性病毒哮鳴的孩童,並比較受試者使用類固醇治療和安慰劑的效果.

資料收集與分析

試驗的品質由兩位審閱者各自獨立評估,研究的論文和研究議題有相關,研究的分類是依據陣發性或每日持續性的給予治療,主要指標為需要服用口服類固醇的事件,次要指標為事件的嚴重度,頻率,時間和父母的治療喜好

主要結論

所納入的文獻中有5篇關於輕微陣發性病毒哮鳴孩童的隨機對照試驗,大部分的孩童並不需要或很少服用口服類固醇,而且也很少住院. 有3篇研究關於學齡前幼童發作時給予的高劑量吸入性類固醇(每天1.6到2.25毫克).其中兩篇是採用交叉試驗,另一篇則是採用平行試驗. 而另兩篇平行試驗則是使用持續劑量的類固醇(每天400微克),其中一篇關於學齡前期孩童的研究,另一篇的研究對象則是7到9歲的兒童. 兩篇有關發作時使用高劑量吸入性類固醇的交叉試驗結果顯示可減少口服類固醇的劑量(相對危險比為0.53,95%信賴區間為0.27到1.04),在這兩個雙盲試驗裡,其治療方式比起安慰劑更為小孩的父母所接受(相對風險為0.64,95%信賴區間為0.48 – 0.87). 當氣喘發作時,使用低維持劑量的吸入性類固醇,並比使用安慰劑的病患明顯減少用量(相對風險為0.82,95%信賴區間為0.23 – 2.90),同時住院需求比例也沒有降低(相對風險為0.21,95%信賴區間為0.01 – 4.11).

作者結論

對於輕微陣發性病毒哮鳴的小孩,發作時給予高劑量的吸入性類固醇,可以部分提供有效的治療方針. 目前並無證據可以支持使用低維持劑量的吸入性類固醇,可以預防和治療病毒誘發的陣發性輕微喘鳴.

翻譯人

本摘要由國泰綜合醫院劉怡敏翻譯

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌

總結

高劑量的吸入性類固醇可以緩解兒童因病毒誘發的陣發性輕微喘鳴,但是沒有證據顯示低劑量持續性的類固醇對復發性和非氣喘相關的病毒性上呼吸道感染有幫助. 發生於兒童的反覆陣發性喘鳴不同於持續性的哮鳴,其於兩次陣發事件之間, 多半沒有症狀出現.類固醇可用以緩解因病毒感染而引起的喘鳴. 回顧這些試驗的結果,發現高劑量的吸入性類固醇可以治療小孩的輕微陣發性病毒喘鳴,但並無證據支持使用低維持劑量的吸入性類固醇,可以預防和治療病毒誘發的陣發性輕微喘鳴.相關議題仍需進行更多研究

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