Intervention Review

Corticosteroids for hospitalised children with acute asthma

  1. Michael Smith1,*,
  2. Shaikh Mohammed SI Iqbal2,
  3. Brian H Rowe3,
  4. Tracy N'Diaye4

Editorial Group: Cochrane Airways Group

Published Online: 20 JAN 2003

Assessed as up-to-date: 29 OCT 2002

DOI: 10.1002/14651858.CD002886

How to Cite

Smith M, Iqbal SMSI, Rowe BH, N'Diaye T. Corticosteroids for hospitalised children with acute asthma. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD002886. DOI: 10.1002/14651858.CD002886.

Author Information

  1. 1

    Craigavon Area Hospital Group Trust, Paediatric Department, Craigavon, Northern Ireland, UK

  2. 2

    Sheffield Children's Hospital, Child Health, Sheffield, South Yorkshire, UK

  3. 3

    University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada

  4. 4

    Sheffield Children's Hospital, Research Office, Sheffield, South Yorkshire, UK

*Michael Smith, Paediatric Department, Craigavon Area Hospital Group Trust, 68 Lurgan Road, Craigavon, Northern Ireland, BT63 5QQ, UK. Mike.Smith@southerntrust.hscni.net.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 JAN 2003

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Abstract

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

Background

Systemic corticosteroids are used routinely in the management of children with severe acute asthma. There is a lack of consensus regarding the agent, dose and route of corticosteroid administration.

Objectives

To determine the benefit of systemic corticosteroids (oral, intravenous, or intramuscular) compared to placebo and inhaled steroids in acute paediatric asthma.

Search methods

All controlled trials were identified from the Cochrane Airways Review Group Register, hand searching of respiratory journals, reference lists and contacts with experts and pharmaceutical companies.

Selection criteria

Studies were included if they described a randomised controlled trial (RCT) involving children aged 1-18 years with severe acute asthma who received oral, inhaled, intravenous or intramuscular corticosteroids. Only studies in which patients required hospital admission were included.

Data collection and analysis

Two reviewers using a standard form extracted all data. All data, numeric calculations and graphic extrapolations were independently confirmed.

Main results

Seven trials were included with a total of 426 children studied (274 with oral prednisone vs. placebo, 106 with intravenous steroids vs placebo and 46 with nebulised budesonide vs prednisolone). A significant number of steroid treated children were discharged early after admission (>4 hours) with an OR of 7.00 (95% CI: 2.98 to 16.45) and NNT of 3 (95%CI: 2 to 8). The length of stay was shorter in the steroid groups with a WMD of -8.75 hours (95% CI: -19.23 to 1.74). There were no significant differences between groups in pulmonary function or oxygen saturation measurements. Children treated with steroids in hospital were less likely to relapse within one to three months with OR 0.19 (95%CI: 0.07 to 0.55) and NNT of 3 (95%CI: 2 to 7). The single small study that compared nebulised budesonide to oral prednisone failed to demonstrate equivalence or a difference between each therapy.

Authors' conclusions

Systemic corticosteroids produce some improvements for children admitted to hospital with acute asthma. The benefits may include earlier discharge and fewer relapses. Inhaled or nebulised corticosteroids cannot be recommended as equivalent to systemic steroids at this time. Further studies examining differing doses and routes of administration for corticosteroids will clarify the optimal therapy.

 

Plain language summary

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

Corticosteroids for hospitalised children with acute asthma

An acute asthma attack in a child often results in a trip to the hospital. In the emergency department steroid drugs are given which may improve the child's condition and allow them to be sent home after a few hours observation. However, some children require continued treatment in hospital. This review asked the question "do steroid drugs help children admitted to hospital with asthma?" We found that steroids given by mouth or through an intravenous tube help children recover from acute asthma. The benefits may include earlier discharge or a shorter stay in hospital. Children were less likely to come back to hospital in the one to three months following the admission. However, the evidence was not overwhelming due to the limited number of studies available and different medicines used. Further research needs to concentrate on the best medications to use and the best route of administration.

 

摘要

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

背景

以皮質類固醇治療因急性氣喘住院的兒童

全身性皮質類固醇被常規使用於處理兒童嚴重的急性氣喘。但是關於藥劑、劑量和給藥途徑等,目前還沒有一致的共識。

目標

與安慰劑和吸入型類固醇比較,確定全身性皮質類固醇(口服、靜脈注射或肌肉注射)對兒童急性氣喘的效益。

搜尋策略

所有試驗都來自於Cochrane Airways Review Group Register、人工搜尋呼吸道期刊和參考資料表,另外並連絡專家及藥廠。

選擇標準

納入隨機對照試驗,其研究對象為1 – 18歲的嚴重急性氣喘兒童,並接受口服、吸入、靜脈注射或肌肉注射皮質類固醇。僅納入住院病患的研究。

資料收集與分析

兩位審查員以標準格式擷取資料。所有數據,無論是數字計算或圖形推算,都經過個別確認。

主要結論

納入七個試驗、共426位兒童(274位比較口服 prednisone和安慰劑,106 位比較靜脈注射類固醇和安慰劑,46位比較噴霧型budesonide 和 prednisolone)。類固醇治療組的兒童住院後出院較早(相差超過四個小時),危險對比值(OR)7.00 (95%信賴區間:2.98到16.45),益一需治數(NTT)為3(95%信賴區間:2到8)。類固醇治療組住院時間較短,加權平均差(WMD) 8.75小時(95%信賴區間:19.23到 1.74)。在肺功能或氧飽和度方面,各組間則沒有顯著差異。住院期間接受類固醇治療的兒童在一到三個月內復發率較低,危險對比值0.19 (95%信賴區間:0.07到0.55),益一需治數為3 (95%信賴區間:2到7)。只有一個小型研究比較噴霧型budesonide和口服prednisone的效果,但其結果無法確認兩組的優劣。

作者結論

全身性皮質類固醇對於因急性氣喘住院的兒童有一些改善的效果。可能的效益包括:較早出院和較少復發。目前無法認定-吸入型或噴霧型皮質類固醇是否和全身性皮質類固醇有相同的效果。還需要進一步研究,檢測皮質類固醇不同劑量和不同給藥途徑的效果,以找出理想的治療方法。

翻譯人

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

總結

類固醇藥物有助於因嚴重氣喘發作住院的兒童。兒童急性氣喘發作通常需要到院處理。在急診室給予類固醇藥物可以改善病童的狀況,讓他們可以在觀察幾個小時後出院回家。然而,有些兒童需要住院持續治療。本回顧提出下列問題:類固醇是否有助於因氣喘住院的兒童?我們發現:口服或靜脈注射類固醇有助於急性氣喘兒童復元。其效益可能包括:較早出院和住院時間較短。而且往後的一到三個月中,需要回到醫院的可能性也較少。然而,因為現有的研究數量有限,而且各研究使用的藥物不同,因此證據還不夠強勢。需要更進一步的研究,致力於鑽研最好的使用藥物和最佳的給藥途徑。