Objective To study the efect of montelukast for improving bronchial hyperresponsiveness (BHR) in treatment of bronchiolitis. Methods Four hundreds infants, 3 to 24 months old, hospitalized with acute bronchiolitis in three Hospitals (Urumqi Children’s Hospital, Pediatrics Department of First Ailiated Hospital of Xinjiang Medical University, and Pediatrics Department of Army General Hospital) from January, 2007 to January, 2008, were randomly assigned into four groups: placebo group (n=92), budesonide group (n=91), montelukast short-course group (7 days, n=88), and montelukast long-course group (28 days, n=90). Main outcome measure was BHR ater treatment, including recurrent bronchiolitis wheezing and asthma incidence rate. Secondary measures were changes in serum T-IgE level and eosinophilic cationic protein (ECP) level. Results All four groups were comparable at baseline. No signiicant diferences were observed between placebo group and budesonide group in changes of serum T-IgE (F=6.17, P=0.00), ECP (F=8.13, P=0.00), recurrent post-bronchiolitis-wheezing (χ2=49.46, P=0.00) and asthma incidence rate (χ2=27.21, P=0.00). Ater treatment with montelukast, there was statistical signiicance in T-IgE and ECP level, times of recurrent bronchiolitis wheezing and asthma incidence rate, as follows, montelukast short-course group versus placebo group (F=12.56, P=0.00), montelukast short-course group versus budesonide group (F=7.22, P=0.00), montelukast long-course group versus placebo group (F=20.48, P=0.00), montelukast long-course group versus budesonide group (F=13.56, P=0.00), montelukast short-course group versus montelukast long-course group (F=1.04, P=0.00). Conclusions Budesonide treatment for 7 days can not improve bronchial hyperresponsiveness induced by bronchiolitis, while montelukast does, that is, montelukast can decrease both the times of bronchiolitis wheezing and asthma incidence rate. Long-course treatment of montelukast is superior to that of short-course.
目的 评价酚妥拉明治疗小儿毛细支气管炎的疗效和安全性。 方法 计算机检索Cochrane图书馆，Medline（1950年－2013年），Embase（1980年－2013年），中国生物医学文献数据库（1978年－2013年）、中国知网（1979年－2013年）、万方（1986年－2013年）、维普（1989年－2013年），收集酚妥拉明联合常规方法对比仅用常规方法治疗小儿毛细支气管炎的随机对照试验（RCT），由两名研究者根据纳入与排除标准筛选文献、提取资料并评价质量后，采用RevMan 5.1软件进行Meta分析。 结果 共纳入13个RCT，1 186例患儿。Meta分析结果显示：在常规治疗基础上加用酚妥拉明，其总有效率[RR=1.30，95%CI（1.15，1.46），P＜0.000 1]、平均住院时间[MD=?2.15 d，95%CI（?2.78，?1.53） d，P＜0.000 01]、啰音消失的平均时间[MD=?1.62 d，95%CI（?2.02，?1.23） d，P＜0.000 01]，憋喘消失的平均时间[MD=?2.39 d，95%CI（?4.64，?0.13）d，P=0.04]差异有统计学意义，而气促消失的平均时间差异无统计学意义[MD=?0.62 d，95%CI（?1.31，0.07）d，P=0.08]。 结论 在常规治疗基础上加用酚妥拉明治疗小儿毛细支气管炎时，其疗效疗效优于仅采用常规治疗，在缓解啰音、憋喘等临床症状上起效更快。而在安全性方面证据不足，需要进一步的研究。
目的:探讨孟鲁司特钠(顺尔宁)对呼吸道合胞病毒(RSV)毛细支气管炎患儿血清中半胱氨酰白三烯(CysLTs)的影响。方法:将60例4～18个月的RSV毛细支气管炎患儿随机分为顺尔宁治疗组(30例)和常规治疗组(30例),常规治疗组仅给予综合治疗,而顺尔宁治疗组在综合治疗的基础上加用孟鲁司特口服,用法为4mg每晚1次口服。于治疗前和治疗后检测血清中CysLTs水平。结果:治疗前,RSV毛细支气管炎两组CysLTs水平均明显高于正常组(Plt;005),同时CysLTs水平较常规治疗组显著下降(Plt;005),常规治疗组患儿血清CysLTs水平仍高于正常组(Plt;005)。结论:顺尔宁可降低RSV毛细支气管炎患儿血清中CysLTs水平,在RSV毛细支气管炎的抗炎机制中起重要作用,推测RSV毛细支气管炎患儿口服孟鲁司特有可能达到早期干预,从另一条途径减少哮喘的发病。
Objective To investigate the effects of montelukast ( MK) on the airway inflammation and the risk of the recurrence of wheezing in the treatment of infants with RSV bronchiolitis.Methods 60 infants ( aged 6-24 months) with RSV bronchiolitis admitted between December 2010 and December 2011 were recruited in the study. They were randomly assigned into a conventional group and a MK group ( n =30 in each group) . All patients received conventional treatments including inhalation of budsonide and so on.The subjects in the MK group received oral montelukast ( 4 mg qn for 12 weeks) additionally. The levels of serum cysteinyl leukotrienes ( CysLTs ) , total immunoglobuline E ( T-IgE) , eosinophil cationic protein ( ECP) and fractional exhaled nitric oxide ( FeNO) were assayed before and after the treatments. Thenumber of recurrence of wheezing was recorded through outpatient and telephone follow-up for 12 months. 30 healthy infants participating the health examination in outpatient were selected as control, and those who got atopic disease or respiratory tract infections recently were excluded. Results The levels of CysLTs, ECP and FeNO of the patients with RSV bronchiolitis before treatment were significantly higher than those in the normal control group, and the levels of CysLTs and FeNO were significantly decreased after treatment ( P lt;0. 05) . The levels of CysLTs and FeNO after treatment in the MK group was significantly lower than those in the conventional group. The level of ECP was significantly decreased after treatment in the MK group ( P lt;0. 05) ,·186· Chin J Respir Crit Care Med, March 2013 , Vol. 12 , No. 2 http: / /www. cjrccm. com which was not significantly changed in the conventional group( P gt; 0. 05) . The number of recurrence of wheezing in the MK group was more less that that in the conventional group ( P lt; 0. 05) . Conclusion Maintenance treatment with montelukast after the treatment of the acute phase of bronchiolitis can prevent recurrence of wheezing by suppressing airway inflammation in infants with RSV bronchiolitis.
Objective To systematically review the efficacy of salbutamol for infants with bronchiolitis. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2016), CBM, VIP, WanFang Data and CNKI were searched from inception to March 2016 to collect randomized controlled trials (RCTs) about salbutamol for infants with bronchiolitis. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed using RevMan 5.3 software. Results A total of 20 RCTs, involving 1 735 patients were included. The results of meta-analysis showed that, compared with the control group, the salbutamol group had shorter cough relief time (MD= –1.44 d, 95%CI –1.93 to –0.95, P < 0.000 01), dyspnear relief time (MD= –0.87 d, 95%CI –1.17 to –0.56, P < 0.000 01), asthmatic remission time (MD= –1.38 d, 95%CI –1.93 to –0.83, P < 0.000 01), pulmonary rales disappear time (MD= –1.58 d, 95%CI –2.00 to –1.17, P < 0.000 01) and average hospitalization time (MD= –1.40 d, 95%CI –2.12 to –0.68, P=0.000 1), but could not improve clinical severity score (MD= –0.17, 95%CI –0.35 to 0.00, P=0.05). Conclusion Current evidence indicates that salbutamol can significantly improve the bronchiolitis with cough, dyspnea and wheezes symptoms and lung’s signs, shorten the length of hospital stay, but can not improve the clinical severity score of infants with bronchiolitis. Due to the limited quality of included studies, more high quality studies are needed to verify the above conclusion.
ObjectiveTo systematically review the methodological quality of guidelines on the management of bronchiolitis in children, then to compare the recommendations and to provide a reference for clinical use. MethodsGuidelines concerning bronchiolitis were electronically retrieved in CNKI, VIP, WanFang Data, CBM, PubMed, EMbase, Medlive, GIN (Guidelines International Network), CGC (China Guideline Chearinghouse), NGC (National Guideline Clearinghouse), AAP (American Academy of Pediatrics), NICE (National Institute for Health and Clinical Excellence) and WHO (World Health Organization) from inception to December 2015. The methodological quality of included guidelines were evaluated according to the AGREE II instrument, and the differences between recommendations were compared. ResultsEight guidelines on bronchiolitis were included, Among them, one guideline was developed by UK, two by US, one by Spain, two by Australia, one by Scottish and one by South Africa. Five of them were evidence-based (EB) guidelines, and 3 were non-EB guidelines. Domain 4 (clarity of presentation) showed the highest scores (81%), then scope and purpose (74%), stakeholder involvement (56%), rigor of development (52%), editorial independence (43%), and scores (42%) were the lowest in domain 3 (applicability). The recommendations of managements and medicines for bronchiolitis were basically consistent, but there were individual differences suggested. ConclusionIn these guidelines, the domain score better is "clarity of presentation" and "scope and purpose ", but the other areas should need to improve. Current our country only has an expert consensus of bronchiolitis, which should be further improved. It's urgent to develop evidence-based guidelines which conforms to the situation of our country, in order to make evidence-based medicine implementation in clinical practice.