降低住院率：有高质量的证据表明严重发作时大剂量吸入糖皮质激素在减少住院方面不如口服糖皮质激素。[42]Hendeles L, Sherman J. Are inhaled corticosteroids effective for acute exacerbations of asthma in children? J Pediatr. 2003;142(2 suppl):S26-S32.http://www.ncbi.nlm.nih.gov/pubmed/12584517?tool=bestpractice.com
系统评价或者受试者＞200名的随机对照临床试验（RCT）。
降低住院率：有高质量的证据表明严重发作时大剂量吸入糖皮质激素在减少住院方面不如口服糖皮质激素。[42]Hendeles L, Sherman J. Are inhaled corticosteroids effective for acute exacerbations of asthma in children? J Pediatr. 2003;142(2 suppl):S26-S32.http://www.ncbi.nlm.nih.gov/pubmed/12584517?tool=bestpractice.com
降低急性发作的治疗失败：没有充分的儿科数据证实急性发作时提高吸入糖皮质激素剂量优于维持剂量。[43]Kew KM, Quinn M, Quon BS, et al. Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children. Cochrane Database Syst Rev. 2016;(6):CD007524.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007524.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/27272563?tool=bestpractice.com
系统评价或者受试者＞200名的随机对照临床试验（RCT）。
降低急性发作的治疗失败：没有充分的儿科数据证实急性发作时提高吸入糖皮质激素剂量优于维持剂量。[43]Kew KM, Quinn M, Quon BS, et al. Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children. Cochrane Database Syst Rev. 2016;(6):CD007524.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007524.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/27272563?tool=bestpractice.com
减少住院和住院时间：有高质量的证据表明轻度和中度发作期，储雾罐和雾化吸入在限制住院率和急诊科治疗时间方面同样有效。[51]Cates CJ, Welsh EJ, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev. 2013;(9):CD000052.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000052.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/24037768?tool=bestpractice.com
系统评价或者受试者＞200名的随机对照临床试验（RCT）。
减少住院和住院时间：有高质量的证据表明轻度和中度发作期，储雾罐和雾化吸入在限制住院率和急诊科治疗时间方面同样有效。[51]Cates CJ, Welsh EJ, Rowe BH. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev. 2013;(9):CD000052.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000052.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/24037768?tool=bestpractice.com
降低住院率：有高质量的证据表明早期给以口服糖皮质激素，在第一个小时应用，与安慰剂比较降低了儿童的入院率。[32]Rowe BH, Spooner C, Ducharme FM, et al. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev. 2001;(1):CD002178.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002178/fullhttp://www.ncbi.nlm.nih.gov/pubmed/11279756?tool=bestpractice.com 父母初始给予口服糖皮质激素在非常规的医疗评估中还没有被证明能够改善治疗效果。[52]Vuillermin P, South M, Robertson C. Parent-initiated oral corticosteroid therapy for intermittent wheezing illnesses in children. Cochrane Database Syst Rev. 2006;(3):CD005311.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005311.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/16856091?tool=bestpractice.com
系统评价或者受试者＞200名的随机对照临床试验（RCT）。
降低住院率：有高质量的证据表明早期给以口服糖皮质激素，在第一个小时应用，与安慰剂比较降低了儿童的入院率。[32]Rowe BH, Spooner C, Ducharme FM, et al. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev. 2001;(1):CD002178.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002178/fullhttp://www.ncbi.nlm.nih.gov/pubmed/11279756?tool=bestpractice.com 父母初始给予口服糖皮质激素在非常规的医疗评估中还没有被证明能够改善治疗效果。[52]Vuillermin P, South M, Robertson C. Parent-initiated oral corticosteroid therapy for intermittent wheezing illnesses in children. Cochrane Database Syst Rev. 2006;(3):CD005311.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005311.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/16856091?tool=bestpractice.com
改善症状和肺功能：有高质量的证据表明：在严重的和危及生命的哮喘，硫酸镁相对于空白对照改善了症状和肺功能，减少住院。[72]Cheuk DK, Chau TC, Lee SL. A meta-analysis on intravenous magnesium sulphate for treating acute asthma. Arch Dis Child. 2005;90:74-77.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1720072/pdf/v090p00074.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/15613519?tool=bestpractice.com[73]Rowe BH, Bretzlaff JA, Bourdon C, et al. Intravenous magnesium sulfate treatment for acute asthma in the emergency department: a systematic review of the literature. Ann Emerg Med. 2000;36:181-190.http://www.ncbi.nlm.nih.gov/pubmed/10969218?tool=bestpractice.com 吸入硫酸镁效果不及静脉应用，尽管有证据表明在严重哮喘发作时吸入硫酸镁有一定效果[61]Knightly R, Milan SJ, Hughes R, et al. Inhaled magnesium sulfate in the treatment of acute asthma. Cochrane Database Syst Rev. 2017 Nov 28;11:CD003898.http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD003898.pub6/fullhttp://www.ncbi.nlm.nih.gov/pubmed/29182799?tool=bestpractice.com 研究并未发现这一轻微获益具有一致性。[62]Alansari K, Ahmed W, Davidson BL, et al. Nebulized magnesium for moderate and severe pediatric asthma: a randomized trial. Pediatr Pulmonol. 2015;50:1191-1199.http://onlinelibrary.wiley.com/wol1/doi/10.1002/ppul.23158/full[61]Knightly R, Milan SJ, Hughes R, et al. Inhaled magnesium sulfate in the treatment of acute asthma. Cochrane Database Syst Rev. 2017 Nov 28;11:CD003898.http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD003898.pub6/fullhttp://www.ncbi.nlm.nih.gov/pubmed/29182799?tool=bestpractice.com
系统评价或者受试者＞200名的随机对照临床试验（RCT）。
改善症状和肺功能：有高质量的证据表明：在严重的和危及生命的哮喘，硫酸镁相对于空白对照改善了症状和肺功能，减少住院。[72]Cheuk DK, Chau TC, Lee SL. A meta-analysis on intravenous magnesium sulphate for treating acute asthma. Arch Dis Child. 2005;90:74-77.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1720072/pdf/v090p00074.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/15613519?tool=bestpractice.com[73]Rowe BH, Bretzlaff JA, Bourdon C, et al. Intravenous magnesium sulfate treatment for acute asthma in the emergency department: a systematic review of the literature. Ann Emerg Med. 2000;36:181-190.http://www.ncbi.nlm.nih.gov/pubmed/10969218?tool=bestpractice.com 吸入硫酸镁效果不及静脉应用，尽管有证据表明在严重哮喘发作时吸入硫酸镁有一定效果[61]Knightly R, Milan SJ, Hughes R, et al. Inhaled magnesium sulfate in the treatment of acute asthma. Cochrane Database Syst Rev. 2017 Nov 28;11:CD003898.http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD003898.pub6/fullhttp://www.ncbi.nlm.nih.gov/pubmed/29182799?tool=bestpractice.com 研究并未发现这一轻微获益具有一致性。[62]Alansari K, Ahmed W, Davidson BL, et al. Nebulized magnesium for moderate and severe pediatric asthma: a randomized trial. Pediatr Pulmonol. 2015;50:1191-1199.http://onlinelibrary.wiley.com/wol1/doi/10.1002/ppul.23158/full[61]Knightly R, Milan SJ, Hughes R, et al. Inhaled magnesium sulfate in the treatment of acute asthma. Cochrane Database Syst Rev. 2017 Nov 28;11:CD003898.http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD003898.pub6/fullhttp://www.ncbi.nlm.nih.gov/pubmed/29182799?tool=bestpractice.com
减少需要口服糖皮质激素治疗的疗程：有中等质量的儿童研究的证据表明在学龄前儿童病毒诱发的哮喘发作中，吸入高剂量的糖皮质激素与空白对照相比可减少口服糖皮质激素的应用疗程。 然而，生长上的不利影响远远超越了激素治疗带来的好处。[50]Ducharme FM, Lemire C, Noya FJ, et al. Preemptive use of high-dose fluticasone for virus-induced wheezing in young children. N Engl J Med. 2009;360:339-353.http://www.nejm.org/doi/full/10.1056/NEJMoa0808907#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/19164187?tool=bestpractice.com
系统评价或者受试者＞200名的随机对照临床试验（RCT）。
减少需要口服糖皮质激素治疗的疗程：有中等质量的儿童研究的证据表明在学龄前儿童病毒诱发的哮喘发作中，吸入高剂量的糖皮质激素与空白对照相比可减少口服糖皮质激素的应用疗程。 然而，生长上的不利影响远远超越了激素治疗带来的好处。[50]Ducharme FM, Lemire C, Noya FJ, et al. Preemptive use of high-dose fluticasone for virus-induced wheezing in young children. N Engl J Med. 2009;360:339-353.http://www.nejm.org/doi/full/10.1056/NEJMoa0808907#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/19164187?tool=bestpractice.com
症状改善和降低入院率：有中等质量的证据表明严重发作时持续的短效β-2受体激动剂治疗在减少住院和改善肺功能方面优于间歇应用。[53]Camargo CA Jr, Spooner CH, Rowe BH. Continuous versus intermittent beta-agonists for acute asthma. Cochrane Database Syst Rev. 2003;(4):CD001115.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001115/fullhttp://www.ncbi.nlm.nih.gov/pubmed/14583926?tool=bestpractice.com[54]Papo MC, Frank J, Thompson AE. A prospective, randomized study of continuous versus intermittent nebulized albuterol for severe status asthmaticus in children. Crit Care Med. 1993;21:1479-1486.http://www.ncbi.nlm.nih.gov/pubmed/8403956?tool=bestpractice.com
系统评价或者受试者＞200名的随机对照临床试验（RCT）。
症状改善和降低入院率：有中等质量的证据表明严重发作时持续的短效β-2受体激动剂治疗在减少住院和改善肺功能方面优于间歇应用。[53]Camargo CA Jr, Spooner CH, Rowe BH. Continuous versus intermittent beta-agonists for acute asthma. Cochrane Database Syst Rev. 2003;(4):CD001115.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001115/fullhttp://www.ncbi.nlm.nih.gov/pubmed/14583926?tool=bestpractice.com[54]Papo MC, Frank J, Thompson AE. A prospective, randomized study of continuous versus intermittent nebulized albuterol for severe status asthmaticus in children. Crit Care Med. 1993;21:1479-1486.http://www.ncbi.nlm.nih.gov/pubmed/8403956?tool=bestpractice.com
改善症状和肺功能：有中等质量的证据表明：在严重的和危及生命的哮喘，静脉注射氨茶碱相对于空白对照改善了肺功能和症状。[55]Roberts G, Newsom D, Gomez K, et al. Intravenous salbutamol bolus compared with an aminophylline infusion in children with severe asthma: a randomised controlled trial. Thorax. 2003;58:306-310.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746646/pdf/v058p00306.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/12668792?tool=bestpractice.com[56]Mitra AA, Bassler D, Watts K, et al. Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators. Cochrane Database Syst Rev. 2005;(2):CD001276.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001276.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/15846615?tool=bestpractice.com[57]Yung M, South M. Randomised controlled trial of aminophylline for severe acute asthma. Arch Dis Child. 1998;79:405-410.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1717748/pdf/v079p00405.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/10193252?tool=bestpractice.com[58]Silveira D'Avila R, Piva J, Cauduro Marostica PJ, et al. Early administration of two intravenous bolus of aminophylline added to the standard treatment of children with acute asthma. Respir Med. 2008;102:156-161.http://www.ncbi.nlm.nih.gov/pubmed/17869497?tool=bestpractice.com 这个证据应该谨慎解读，由于荟萃分析深受样本最大的随机对照研究影响，这也是唯一的证明有效的随机对照研究。
系统评价或者受试者＞200名的随机对照临床试验（RCT）。
改善症状和肺功能：有中等质量的证据表明：在严重的和危及生命的哮喘，静脉注射氨茶碱相对于空白对照改善了肺功能和症状。[55]Roberts G, Newsom D, Gomez K, et al. Intravenous salbutamol bolus compared with an aminophylline infusion in children with severe asthma: a randomised controlled trial. Thorax. 2003;58:306-310.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746646/pdf/v058p00306.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/12668792?tool=bestpractice.com[56]Mitra AA, Bassler D, Watts K, et al. Intravenous aminophylline for acute severe asthma in children over two years receiving inhaled bronchodilators. Cochrane Database Syst Rev. 2005;(2):CD001276.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001276.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/15846615?tool=bestpractice.com[57]Yung M, South M. Randomised controlled trial of aminophylline for severe acute asthma. Arch Dis Child. 1998;79:405-410.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1717748/pdf/v079p00405.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/10193252?tool=bestpractice.com[58]Silveira D'Avila R, Piva J, Cauduro Marostica PJ, et al. Early administration of two intravenous bolus of aminophylline added to the standard treatment of children with acute asthma. Respir Med. 2008;102:156-161.http://www.ncbi.nlm.nih.gov/pubmed/17869497?tool=bestpractice.com 这个证据应该谨慎解读，由于荟萃分析深受样本最大的随机对照研究影响，这也是唯一的证明有效的随机对照研究。
改善临床结局：有中等质量的证据表明在危及生命的哮喘，静脉注射沙丁胺醇（舒喘灵）与空白对照相比改善了临床结局[75]Kirby C. Comparison of intravenous and inhaled salbutamol in severe acute asthma. Pediatr Rev Commun. 1988;3:67-77.[76]Browne GJ, Penna AS, Phung X, et al. Randomised trial of intravenous salbutamol in early management of acute severe asthma in children. Lancet. 1997;349:301-305.http://www.ncbi.nlm.nih.gov/pubmed/9024371?tool=bestpractice.com[77]Browne GJ, Lam LT. Single-dose intravenous salbutamol bolus for managing children with acute severe asthma in the emergency department: reanalysis of data. Pediatr Crit Care Med. 2002;3:117-123.http://www.ncbi.nlm.nih.gov/pubmed/12780979?tool=bestpractice.com 一项 Meta 分析未能证实这一改善，[78]Travers A, Jones AP, Kelly K, et al. Intravenous beta2-agonists for acute asthma in the emergency department. Cochrane Database Syst Rev. 2001:(1):CD002988.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002988/fullhttp://www.ncbi.nlm.nih.gov/pubmed/11406055?tool=bestpractice.com 但其结论受到质疑。[55]Roberts G, Newsom D, Gomez K, et al. Intravenous salbutamol bolus compared with an aminophylline infusion in children with severe asthma: a randomised controlled trial. Thorax. 2003;58:306-310.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746646/pdf/v058p00306.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/12668792?tool=bestpractice.com
系统评价或者受试者＞200名的随机对照临床试验（RCT）。
改善临床结局：有中等质量的证据表明在危及生命的哮喘，静脉注射沙丁胺醇（舒喘灵）与空白对照相比改善了临床结局[75]Kirby C. Comparison of intravenous and inhaled salbutamol in severe acute asthma. Pediatr Rev Commun. 1988;3:67-77.[76]Browne GJ, Penna AS, Phung X, et al. Randomised trial of intravenous salbutamol in early management of acute severe asthma in children. Lancet. 1997;349:301-305.http://www.ncbi.nlm.nih.gov/pubmed/9024371?tool=bestpractice.com[77]Browne GJ, Lam LT. Single-dose intravenous salbutamol bolus for managing children with acute severe asthma in the emergency department: reanalysis of data. Pediatr Crit Care Med. 2002;3:117-123.http://www.ncbi.nlm.nih.gov/pubmed/12780979?tool=bestpractice.com 一项 Meta 分析未能证实这一改善，[78]Travers A, Jones AP, Kelly K, et al. Intravenous beta2-agonists for acute asthma in the emergency department. Cochrane Database Syst Rev. 2001:(1):CD002988.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002988/fullhttp://www.ncbi.nlm.nih.gov/pubmed/11406055?tool=bestpractice.com 但其结论受到质疑。[55]Roberts G, Newsom D, Gomez K, et al. Intravenous salbutamol bolus compared with an aminophylline infusion in children with severe asthma: a randomised controlled trial. Thorax. 2003;58:306-310.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746646/pdf/v058p00306.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/12668792?tool=bestpractice.com
