Oral prednisolone in the acute management of children age 6 to 35 months with viral respiratory infection-induced lower airway disease: a randomized, placebo-controlled trial

Oral and inhaled corticoid treatment for wheezing in the first year of life

“…Em relação aos estudos sobre a utilização de CI para o tratamento da sibilância em lactentes, existem diferenças nos critérios de seleção das crianças, nas estratégias de tratamento, na coleta dos dados e nos desfechos considerados 8,[13][14][15][16][17][18][19][20][21][22][23][24][25] . Apesar disso, é possível concluir que a utilização de CI em lactentes pode, em algumas situações, possibilitar um melhor controle dos sintomas que, porém, não se sustenta após a suspensão do mesmo, ou seja, não interfere A principal limitação do presente estudo compreende o fato de as frequências de uso de CO e CI serem estimadas pelo relato dos pais ou responsáveis pela criança e não através de registros médicos, o que seria mais confiável.…”

Update on the utility of corticosteroids in acute pediatric respiratory disorders

“…Tal et al 27 randomized preschool children with histories of at least three wheezing episodes to receive a single dose of 4 mg/kg of intramuscular methylprednisolone or placebo and reported that corticosteroid treatment was associated with a significantly lower proportion of participants requiring admission (20% versus 43%, p Ͻ 0.05) and with a significant improvement in respiratory symptom scores. Csonka et al 28 randomized preschool children to receive oral prednisolone (2-mg/kg per day for three days) and found no difference in the proportions of admitted children (54% versus 53%; p ϭ 0.88); OCSs treatment, among the children who were eventually hospitalized was associated with a numerically, but not statistically significant, shorter duration of hospital stay (two versus three days, p ϭ 0.06). Patient characteristics in that study 28 limit its external validity, because ϳ40% of the participants had never been treated previously for wheezing.…”

“…Csonka et al 28 randomized preschool children to receive oral prednisolone (2-mg/kg per day for three days) and found no difference in the proportions of admitted children (54% versus 53%; p ϭ 0.88); OCSs treatment, among the children who were eventually hospitalized was associated with a numerically, but not statistically significant, shorter duration of hospital stay (two versus three days, p ϭ 0.06). Patient characteristics in that study 28 limit its external validity, because ϳ40% of the participants had never been treated previously for wheezing.…”

Le petit enfant «obstructif»

“…On ne dispose d'aucune preuve montrant que l'augmentation temporaire de la dose de sté-roïdes inhalés ait un effet bénéfique sur un épisode infectieux [13]. Pendant une exacerbation aiguë, l'administration à court terme de stéroïdes systémiques montre une efficacité nettement supérieure à celle des stéroïdes inhalés [14,15]. Lorsque l'on utilise des sté-roïdes systémiques, il faut éventuellement rehausser le niveau de traitement après avoir vérifié la compliance et la technique d'inhalation du patient.…”

“…L' administration de stéroïdes systémiques en routine n'est pas recommandée, car aucune étude n'a démontré leur utilité pratique dans les bronchites obstructives péri-infectieuses [19]. Ce n'est que lors des exacerbations sévères à risque vital que l'on peut envisager d'administrer des stéroïdes systémiques dès le début (0,2 mg/kg/jour de Betnesol ou 1 à 2 mg/kg/jour de prednisolone pendant 3 à 5 jours) [14]. Il n'existe que de rares études sur l'utilisation des antagonistes des récepteurs des leucotriènes (LTRA) en cas de bronchites épiso-diques obstructives virales, et elles montrent que les médicaments de cette classe n'exercent aucun effet sur le nombre d'hospitalisations, la durée des épisodes ou les besoins en stéroïdes.…”