使用皮质类固醇治疗儿童哮喘

Owen Hibberd, Agata Anna Chylinska, Katie Finn, Melanie Ranaweera, Dani Hall
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摘要

#### 要点 一名两岁的儿童因咳嗽、肋下凹陷和间歇性喘鸣被送到急诊科。其父母对这些症状表示担忧,并要求尽可能采取最佳治疗方法来改善症状,减少进一步治疗或入院的需要。对于任何出现喘鸣的患儿,必须考虑广泛的鉴别因素(表 1)。1 鼓噪(又称喉气管炎)是导致 6-36 个月儿童喘鸣和上呼吸道阻塞的常见原因。2 最近,SARS-CoV-2 也成为一种病因,而且通常发生在年龄较大的儿童群体中。-1 6 因此,治疗的主要方法是在急诊科口服皮质类固醇激素,并在有适当安全网的情况下出院。7 值得注意的是,最近对患有 SARS-CoV-2 和 Croup 的儿童进行的研究发现,他们的病情更加严重,需要更多肾上腺素,更需要重症监护:表 1 儿童哮鸣音的鉴别标准 Westley Croup 评分(表 2)是一种标准化评分方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Use of corticosteroids for croup in children
### Key points A 2-year-old child is brought to the emergency department with a barking cough, subcostal recessions and intermittent stridor. Concerned about the symptoms, their parents are asking for the best possible treatment to improve the symptoms and reduce the need for further treatment or admission. In any child presenting with stridor, it is important to consider a wide range of differentials (table 1).1 Croup (also called laryngotracheitis) is a common cause of stridor and upper airway obstruction in children aged 6–36 months.2 Croup usually occurs in the winter months and is most frequently caused by human parainfluenza virus types 1 and 2; less commonly, other respiratory viruses, such as respiratory syncytial virus, can also cause croup.2 Recently, SARS-CoV-2 has emerged as a cause and can often occur in an older demographic of children.3–6 Research involving large cohorts of children with croup has demonstrated that only a small proportion require hospital admission.1 6 Therefore, the mainstay of treatment is oral corticosteroids in the emergency department and discharge with an appropriate safety net.2 7 It is important to note that recent studies involving children with SARS-CoV-2 and croup have observed a more severe illness, a greater requirement for epinephrine and a greater need for intensive care.3–6 8 As such, although the treatment is the same, clinicians should be mindful of the probability of a more severe illness when treating children with COVID-19 and croup.3–6 8 View this table: Table 1 Differentials of stridor in children The Westley Croup Score (table 2) is a standardised scoring …
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