Inhaled steroids in the treatment of pertussis

Background. Pertussis again became a serious problem in the 21st century. The decrease in vaccination coverage, the use of acellular vaccines that create a shorter immunity, and most importantly, a change in the epidemiology of the infection as a result of half a century of mass vaccination, has led to an increase in the incidence of disease in adolescents with waning immunity who infect infants. Until now, there are no reliable drugs for the pertussis treatment; antibiotics have an intermittent effect, and only with very early prescription, symptomatic agents are ineffective, and the infants are especially affected, until deaths. In the literature, there are indications of the effectiveness of systemic glucocorticosteroids in severe pertussis, only a few works concern the use of inhaled glucocorticosteroids (IGCS). Objective: currently, when pertussis infection again becomes relevant, we want to share the experience of using IGCS in pertussis and draw the attention of pediatricians to this safe opportunity to alleviate the manifestations of this infection. Methods. An observational study on the use of IGCS included 16 children of different ages hospitalized with frequent severe spasmodic attacks in a pediatric boxed department, including 3 children of the first months of life with complicated pertussis hospitalized in ICU. Budesonide was used together with the antitussive drug butamirate; macrolides were prescribed to reduce the excretion of the pathogen. Results. In all cases, the use of budesonide with butamirate in children in the boxed department led to the decrease in the frequency of cough and reduction of the severity of coughing attacks from the 2nd day, especially at night, with rapid improvement of the condition of patients, that led to the reduced the length of hospitalization to 2-3 days for senior children and to 3-6 days for younger children. In children of the first months of life with complicated forms of pertussis, the administration of IGCS with butamirate led to rapid relief of spasmodic cough and apnea, and allowed to focus on the treatment of pneumonia. Conclusion. According to the authors, IGCS therapy with butamirate should be carried out from the first days of a paroxysmal cough, which helps to alleviate the course of the spasmodic period of pertussis and reduce its duration.

pertussis, inhaled glucocorticosteroids, budesonide, butamirate