2017, Número 2
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Rev Cubana Pediatr 2017; 89 (2)
Estudio aleatorizado abierto de niños con exacerbación aguda del asma tratados con esteroides inhalados
Kassisse E, Prada L, Salazar I, García H, Kassisse J
Idioma: Español
Referencias bibliográficas: 35
Paginas: 165-176
Archivo PDF: 305.58 Kb.
RESUMEN
Introducción: la terapia primaria en la crisis de asma aguda, incluye administración de oxígeno, uso de β
2-agonistas por vía inhalada y la administración de esteroides sistémicos. Las ventajas que se citan sobre el uso de los esteroides inhalados serían, su rápido inicio de acción y su buen perfil de seguridad, en contraposición a los esteroides sistémicos.
Objetivo: evaluar la utilidad de los corticoides inhalados en el tratamiento de la crisis de asma aguda en niños mayores de 2 años.
Métodos: se realizó un estudio prospectivo, transversal, experimental, aleatorizado, de eficacia clínica; la selección se realizó por medio de una tabla de números aleatorios, y se incluyeron tres grupos: el I recibió terapia estándar, el II la sustitución del esteroide sistémico por el inhalado y el III combinó a la terapia estándar el esteroide inhalado. El análisis estadístico se realizó por medio de ANOVA y
chi cuadrado con una p ‹ 0,05 como significativa.
Resultados: se estudiaron 165 pacientes, los tres grupos de tratamiento mejoraron la escala de severidad inicial. Los pacientes que recibieron esteroides inhalados adicionados a la terapia estándar, tuvieron 73 % de posibilidades de no ser hospitalizados, 27 % de posibilidades de reducir el riesgo de hospitalizaciones y de cada 100 pacientes tratados con la combinación, se pudieran prevenir 8 hospitalizaciones.
Conclusiones: los esteroides inhalados muestran equivalencia terapéutica a los esteroides sistémicos.
REFERENCIAS (EN ESTE ARTÍCULO)
Masoli M, Fabian D, Holt S, Beasley R. The global burden of asthma: executive summary of the GINA Dissemination Committee Report. Allergy. 2004;59:469-78.
Weiss K, Sullivan S, Lyttle C. Trends in the cost of illness for asthma in the United States, 1985-1994. J Allergy Clin Immuno. 2000;106:493-9.
Roy S, Milgron H. Management of the acute exacerbation of asthma. J Asthma. 2003;40:593-604.
Urso D. Treatment for acute asthma in the Emergency Department: practical aspects. Eur Rev Med Pharmacol Sci. 2010;14(3):209-14.
Powell R. Acute severe asthma. Journal of Paediatrics and Child Health. 2016;52:187-91.
Schuh S, Reisman J, Alshehri M, Dupuis A, Corey M, Arseneault R, et al. A comparison of inhaled fluticasone and oral prednisone for children with severe acute asthma. N Engl J Med. 2000;343:689-94.
Volovitz B, Bentur I, Finkelstein Y. Effectiveness and safety of inhaled corticosteroids in controlling acute asthma attacks in children who were treated in the emergency department: a controlled comparative study with oral prednisolone. J Allergy Clin Immunol. 1998;102:605-9.
Upham B, Mollen C, Scarfone R, Seiden J, Chew A, Zorc J. Nebulized budesonide added to standard pediatric emergency department treatment of acute asthma: a randomized, double-blind trial. Acad Emerg Med. 2011;18:665-73.
Nuhoglu Y, Bahceciler N, Barlan I, Müjdat M. The effectiveness of high-dose inhaled budesonide therapy in the treatment of acute asthma exacerbations in children. Ann Allergy Asthma Immunol. 2001,86:318-22.
Edmonds M, Camargo C, Pollack C, Rowe B. The effectiveness of inhaled corticosteroids in the emergency department treatment of acute asthma: a meta-analysis. Ann Emerg Med. 2002;40:145-50.
Horvath G, Vasas A, Wanner A. Inhaled corticosteroids reduce asthma-associated airway hyperperfusion through genomic and nongenomic mechanisms. Pulm Pharmacol Ther. 2007;20:157-62.
Mendes E, Cadet L, Arana J, Wanner A. Acute effect of an inhaled glucocorticosteroid on albuterol-induced bronchodilation in patients with moderately severe asthma. Chest. 2015;147(4):1037-42.
Volovitz B, Nussinovitch M, Finkelstein Y, Harel L, Varsano I. Effectiveness of inhaled corticosteroids in controlling acute asthma exacerbations in children at home. Clin Pediatr. 2001;40:79-86.
Rodrigo G. Rapid effects of inhaled corticosteroids in acute asthma: an evidence-based evaluation. Chest. 2006;130:1301-11.
Vathenen A, Knox A, Wisniewski A, Tattersfield A. Time course of change in bronchial reactivity with an inhaled corticosteroid in asthma. Am Rev Respir Dis. 1991;143(6):1317-21.
Hsu P, Lam LT, Browne G. The pulmonary index score as a clinical assessment tool for acute childhood asthma. Ann Allergy Asthma Immunol. 2010;105:425-9.
Expert Panel Report 3 (EPR-3): guidelines for the diagnosis and management of asthma-summary report 2007. J Allergy Clin Immunol. 2007;120:S94-S138.
Global strategy for asthma management and prevention. Global Initiative for Asthma (GINA) [homepage en Internet]; GINA, 2016 [citado 28 de Agosto de 2016]. Disponible en: http://ginasthma.org/
Agertoft L, Andersen A, Weibull E, Pedersen S. Systemic availability and pharmacokinetics of nebulised budesonide in preschool children. Arch Dis Child. 1999;80:241-7.
Takeshi K, Kenichi T, Atsushi I, Eiji M, Yutaka U, Toshio K. Usefulness of modified Pulmonary Index Score (mPIS) as a quantitative tool for the evaluation of severe acute exacerbation in asthmatic children. Allergology International. 2015;64:139-44.
Ducharme FM, Chalut D, Plotnick L, Savdie C, Kudirka D, Zhang X. The Pediatric Respiratory Assessment Measure: a valid clinical score for assessing acute asthma severity from toddlers to teenagers. J Pediatr. 2008;152:476-80.
Buyuktiryaki A, Civelek E, Can D, Orhan F, Aydogan M, Reisli I. Predicting hospitalization in children with acute asthma. J Emerg Med. 2013;44:919-27.
Devidayal S, Singhi S, Kumar L, Jayshree M. Efficacy of nebulized budesonide compared to oral prednisolone in acute bronchial asthma. Acta Paediatr. 1999;88:835-40.
Nuhoglu Y, Nuhoglu A. Acute effect of nebulized budesonide in asthmatic children. J Invest Allergol Clin Immunol. 2005;15:197-200.
25.Milani G, Rosário N, Riedi C, Figueiredo B. Nebulized budesonide to treat acute asthma in children. J Pediatr (Rio J). 2004;80:106-12.
McFadden E, Kiser R, DeGroot W. Acute bronchial asthma. Relations between clinical and physiologic manifestations. N Engl J Med. 1973;288:221-5.
Beckhaus A, Riutort M, Castro-Rodriguez JA.Inhaled versus systemic corticosteroids for acute asthma in children. A systematic review. Pediatric Pulmonology. 2014;49:326-34.
Su X, Yu N, Kong L, Kang J. Effectiveness of inhaled corticosteroids in the treatment of acute asthma in children in the emergency department: A meta-analysis. Annals of Medicine. 2014;46:24-30.
Manjra A, Price J, Lenney W, Hughes S, Barnacle H. Efficacy of nebulized fluticasone propionate compared with oral prednisolone in children with an acute exacerbation of asthma. Respir Med. 2000;94:1206-14.
Nakanishi A, Klasner A, Rubin B. A randomized controlled trial of inhaled flunisolide in the management of acute asthma in children. Chest. 2003;124:790-4.
Volovitz B. Inhaled budesonide in the management of acute worsenings and exacerbations of asthma: A review of the evidence. Respir Med. 2007;101:685-95.
Bottaro F. Claves para la interpretación de conceptos estadísticos en estudios de investigación. Hematología. 2013;71:299-305.
Rowe B, Bota G, Fabris L, Therrien S, Milner R, Jacono J. Inhaled budesonide in addition to oral corticosteroids to prevent asthma relapse following discharge from the emergency department: a randomized controlled trial. JAMA. 1999;281:2119-26.
Akhtaruzzaman M, Ahmed S, Hoque M, Choudhury A, Hossain M, Islam M, et al. Effects of nebulized budesonide as an adjunct to standard treatment of asthma exacerbations: a randomized, double-blind, placebo-controlled trial. Mymensingh Med J. 2014;23:418-25.
Razi C, Akelma K, Harmanci K, Kocak M, Kuras C. The addition of inhaled budesonideto standard therapy shortens the length of stay in hospital for asthmatic preschool children: A randomized, double-blind, placebo-controlled trial. Int Arch Allergy Immunol. 2015;166:297-303.