Short- and long-term efficacy of prednisolone for first acute rhinovirus-induced wheezing episode.
Short- and long-term efficacy of prednisolone for first acute rhinovirus-induced wheezing episode.
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DOI：
10.1016/j.jaci.2014.07.001
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发表时间：
2015-03
期刊：
影响因子：
--
通讯作者：
Ruuskanen O
中科院分区：
文献类型：
--
作者：
Jartti T;Nieminen R;Vuorinen T;Lehtinen P;Vahlberg T;Gern J;Camargo CA Jr;Ruuskanen O
鼻病毒引起的喘息是反复喘息的重要危险因素。目前还没有关于全身性皮质类固醇对这种疾病患者的影响的随机对照试验。我们试图研究泼尼松龙治疗首次急性、中度至重度鼻病毒引起的婴幼儿喘息发作的短期和长期效果。在通过PCR确认鼻咽抽吸物中存在鼻病毒后，79名3至23个月首次喘息发作的儿童随机接受口服泼尼松龙（首次剂量为2 mg/kg，随后2 mg/kg/d，分2次给药，持续3天）或安慰剂。在整个12个月的随访期间，试验是双盲的。主要结局是长期的：2个月内新的医生确认的喘息发作，12个月内医生确认的喘息发作次数，12个月内开始常规控制性药物治疗哮喘症状。主要相互作用分析检查鼻病毒载量。74例患者完成了研究（平均年龄，13个月; 28%特应性）。两组之间的长期结局无差异（所有P ≥ .30）。在短期结果方面，泼尼松龙组在2周内咳嗽、鼻炎、嘈杂呼吸、严重呼吸困难和夜间呼吸道症状较少（均P <0.05）。25例鼻病毒拷贝数大于7000拷贝/毫升（最敏感的临界值）的儿童与安慰剂相比，在2个月和12个月内经医生证实的复发风险较低方面，泼尼松龙组获益（均P <0.05）。泼尼松龙不能常规推荐给所有首次出现急性、中度至重度鼻病毒诱导的喘息发作的幼儿。泼尼松龙可能对高病毒载量的儿童亚组有益。
Rhinovirus-induced wheezing is an important risk factor for recurrent wheezing. There are no randomized controlled trials on the effect of systemic corticosteroids in patients with this disease. We sought to study the short- and long-term effects of prednisolone treatment of the first acute, moderate-to-severe, rhinovirus-induced wheezing episode in young children. After confirming rhinovirus from nasopharyngeal aspirate by using PCR, 79 children with a first wheezing episode at age 3 to 23 months were randomized to receive oral prednisolone (first dose of 2 mg/kg, followed by 2 mg/kg/d in 2 divided doses for 3 days) or placebo. The trial was double blind throughout the 12-month follow-up. The primary outcomes were long term: new physician-confirmed wheezing episode within 2 months, number of physician-confirmed wheezing episodes within 12 months, and initiation of regular controller medication for asthma symptoms within 12 months. The primary interaction analysis examined rhinovirus load. Seventy-four patients completed the study (mean age, 13 months; 28% atopic). Long-term outcomes did not differ between groups (all P ≥ .30). For short-term outcomes, the prednisolone group had less cough, rhinitis, noisy breathing, severe breathing difficulties, and nocturnal respiratory symptoms at home within 2 weeks (all P < .05). The 25 children with greater than 7000 rhinovirus copies/mL (most sensitive cutoff) benefitted from prednisolone in terms of less risk of physician-confirmed recurrence within 2 and 12 months compared with placebo (both P < .05). Prednisolone cannot be routinely recommended for all young children experiencing their first acute, moderate-to-severe, rhinovirus-induced wheezing episode. Prednisolone might be beneficial in a subgroup of children with high viral loads.
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