Estudio aleatorizado abierto de niños con exacerbación aguda del asma tratados con esteroides inhalados

Elias Ibrahim Kassisse, Linair Prada, Ixora Salazar, Hecmary García, Jorge Kassisse

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Introducción: la terapia primaria en la crisis de asma aguda, incluye administración de oxígeno, uso de β2-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

Masoli M, Fabian D, Holt S, Beasley R. The global burden of asthma: executive summary of the GINA Dissemination Committee Report. Allergy 2004; 59: 469-478.

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):209-214.

Powell. R Acute severe asthma Journal of Paediatrics and Child Health 2016; 52:187–191.

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: 689–694.

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; 102:605–09.

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; 18:665–673.

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, 86:318-322.

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; 40:145-15.

Horvath G, Vasas A, Wanner A. Inhaled corticosteroids reduce asthma-associated airway hyperperfusion through genomic and nongenomic mechanisms. Pulm Pharmacol Ther 2007; 20:157–162.

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 –1042.

Volovitz B, Nussinovitch M, Finkelstein Y, Harel L, Varsano I. Effectiveness of inhaled corticosteroids in controlling acute asthma exacerbations in children at home. Clin Pediatr2001; 40:79–86.

Rodrigo G. Rapid effects of inhaled corticosteroids in acute asthma: an evidence-based evaluation. Chest. 2006; 130:1301–1311.

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): 1317–1321

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) 2016. Disponible en URL: http:// www.ginasthma.org visitada el 28 de Agosto 2016.

Agertoft L, Andersen A, Weibull E, Pedersen S. Systemic availability and pharmacokinetics of nebulised budesonide in preschool children. Arch Dis Child. 1999; 80:241 – 247

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 - 144.

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; 44:919-927.

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 – 840.

Nuhoglu Y, Nuhoglu A. Acute effect of nebulized budesonide in asthmatic children. J. Invest. Allergol. Clin. Immunol. 2005; 15: 197–200.

Milani G, Rosário N, Riedi C, Figueiredo B. Nebulized budesonide to treat acute asthma in children. J Pediatr (Rio J) 2004; 80:106-112.

McFadden E, Kiser R, DeGroot W. Acute bronchial asthma. Relations between clinical and physiologic manifestations. N Engl J Med 1973; 288: 221-225.

Beckhaus A, Riutort M, Castro-Rodriguez JA, Inhaled Versus Systemic Corticosteroids for Acute Asthma in Children. A Systematic Review Pediatric Pulmonology 2014; 49: 326 – 334.

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: 1206–1214.

Nakanishi A, Klasner A, Rubin B. A randomized controlled trial of inhaled flunisolide in the management of acute asthma in children. Chest 2003; 124:790–794.

Volovitz B. Inhaled budesonide in the management of acute worsenings and exacerbations of asthma: A review of the evidence. Respir Med 2007; 101: 685–695.

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; 281:2119-2126.

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; 23:418-425.

Razi C, Akelma K, Harmanci K, Kocak M, Kuras C. The Addition of Inhaled Budesonide to 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.

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Copyright (c) 2017 Elias Ibrahim Kassisse, Linair Prada, Ixora Salazar, Hecmary García, Jorge Kassisse

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