급성세기관지염에서 전신 스테로이드제 치료에 따른 임상 양상
Systemic steroid treatment of acute bronchiolitis: A retrospective study
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: Previous studies have reported that clinical efficacy of steroid therapy for acute bronchiolitis is controversial. However, since it is still frequently used in clinical practice, we sought to re-evaluate its effectiveness. Methods: This study included 277 children with acute bronchiolitis who were admitted to Kyungpook National University Children’s Hospital from March 2013 to July 2016. Erythrocyte sedimentation rates, C-reactive protein (CRP) levels, and viral polymerase chain reaction testing results were obtained, and respiratory rate (RR) was measured periodically. Forty-eight patients were treated with an intravenous (IV) steroid (17.3%, IV group) and 19 patients were treated with a per oral (PO) steroid medication (6.9%, PO group). The remaining 210 patients were steroid-free patients (74.2%, nonsteroid group). Results: RR and CRP levels were higher in the IV group, along with a longer hospitalization period and duration of wheezing. The rate of change from the fastest initial RR to the mean RR on the first treatment day was greatest in the IV group; this finding was statistically significant after controlling for initial RR (16.06% in the IV group, 3.94% in the PO group, 4.90% in the nonsteroid group; P<0.01). Conclusion: There was a trend of IV steroid treatment toward more severe bronchiolitis. A significant reduction in RR on the first day of steroid treatment was observed in IV steroid-treated patients. IV steroid therapy may play a positive role in initial RR stabilization for severe bronchiolitis.
Abstract
Purpose: Previous studies have reported that clinical efficacy of steroid therapy for acute bronchiolitis is controversial. However, since it is still frequently used in clinical practice, we sought to re-evaluate its effectiveness. Methods: This study included 277 children with acute bronchiolitis who were admitted to Kyungpook National University Children’s Hospital from March 2013 to July 2016. Erythrocyte sedimentation rates, C-reactive protein (CRP) levels, and viral polymerase chain reaction testing results were obtained, and respiratory rate (RR) was measured periodically. Forty-eight patients were treated with an intravenous (IV) steroid (17.3%, IV group) and 19 patients were treated with a per oral (PO) steroid medication (6.9%, PO group). The remaining 210 patients were steroid-free patients (74.2%, nonsteroid group). Results: RR and CRP levels were higher in the IV group, along with a longer hospitalization period and duration of wheezing. The rate of change from the fastest initial RR to the mean RR on the first treatment day was greatest in the IV group; this finding was statistically significant after controlling for initial RR (16.06% in the IV group, 3.94% in the PO group, 4.90% in the nonsteroid group; P<0.01). Conclusion: There was a trend of IV steroid treatment toward more severe bronchiolitis. A significant reduction in RR on the first day of steroid treatment was observed in IV steroid-treated patients. IV steroid therapy may play a positive role in initial RR stabilization for severe bronchiolitis.
참고문헌 (20)
- Wright A, "The Tucson children's respiratory study. II: lower respiratory tract illness in the first year of life", Pediatr Infect Dis J, 9, pp.686~ (1990)
- Hall CB, "The burden of respiratory syncytial virus infection in young children", N Engl J Med, 360, pp.588~598 (2009)
- Nair H, "Global burden of acute lower respiratory infections due to respiratory syncytial virus in young children: a systematic review and meta-analysis", Lancet, 375, pp.1545~1555 (2010)
- 김현정, "호흡기 바이러스 및 아토피 소견이 세기관지염의 중증도에 미치는 영향", Allergy Asthma & Respiratory Diseases, 21(4), pp.302~312 (2011), 대한 소아알레르기 호흡기학회
- Shay DK, "Bronchiolitis-associated hospitalizations among US children, 1980-1996", JAMA, 282, pp.1440~1446 (1999)
- Ralston SL, "Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis", Pediatrics, 134, pp.e1474~e1502 (2014)
- Castro-Rodriguez JA, "Principal findings of systematic reviews for the management of acute bronchiolitis in children", Paediatr Respir Rev, 16, pp.267~275 (2015)
- Baumer JH, "SIGN guideline on bronchiolitis in infants", Arch Dis Child Educ Pract Ed, 92, pp.ep149~ep151 (2007)
- Turner T, "Evidence based guideline for the management of bronchiolitis", Aust Fam Physician, 37(6 Spec No), pp.6~13 (2008)
- 김정선, "인천 지역에서 급성 세기관지염의 치료 실태", Allergy Asthma & Respiratory Diseases, 16(2), pp.150~161 (2006), 대한 소아알레르기 호흡기학회
- Patel H, "Glucocorticoids for acute viral bronchiolitis in infants and young children", Cochrane Database Syst Rev, (3), pp.CD004878~ (2004)
- Garrison MM, "Systemic corticosteroids in infant bronchiolitis: a meta-analysis", Pediatrics, 105, pp.E44~ (2000)
- Blom DJ, "WITHDRAWN: inhaled corticosteroids during acute bronchiolitis in the prevention of post-bronchiolitic wheezing", Cochrane Database Syst Rev, (1), pp.CD004881~ (2011)
- Hartling L, "Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis", BMJ, 342, pp.d1714~ (2011)
- Bunch C, "Prednisone drugdex drug evaluation", Micromedex Healthcare Ser, 100 (1998)
- Katzung BG, "Basic and clinical pharmacology" (1998), Appleton & Lange
- Thomas LH, "Infection of gnotobiotic calves with a bovine and human isolate of respiratory syncytial virus. Modification of the response by dexamethasone", Arch Virol, 79, pp.67~77 (1984)
- Guilbert TW, "Atopic characteristics of children with recurrent wheezing at high risk for the development of childhood asthma", J Allergy Clin Immunol, 114, pp.1282~1287 (2004)
- Behrendt CE, "International variation in the management of infants hospitalized with respiratory syncytial virus. International RSV Study Group", Eur J Pediatr, 157, pp.215~220 (1998)
- Fernandes RM, "Glucocorticoids for acute viral bronchiolitis in infants and young children", JAMA, 311, pp.87~88 (2014)