Article type
Year
Abstract
Introduction/Objective: To determine the effectiveness of steroids for preventing hospitalization when used early in the emergency treatment of acute asthma exacerbations.
Methods: A search of the Airways Review Group data base was conducted to identify randomized placebo controlled trials of corticosteroids for acute asthma. Foreign language and unpublished trials were sought; bibliography searches and author contacts were used. Two reviewers independently reviewed studies for relevance, inclusion, quality scoring, and data extraction.
Results: We identified 9 original publications for inclusion representing 787 patients. The combined estimate of effect showed a benefit to steroid treatment (odds ratio (OR) = 0.36; 95% confidence interval (Cl): 0.19, 0.69). However, this effect was not demonstrated until 4 hours of treatment (4 hours OR: 0.45; 95% Cl: 0.23, 0.86 & 6 hour OR: 0.28: 95% Cl: 0.09, 0.84). This benefit was less pronounced for patients receiving steroid therapy at ED presentation. These results suggest that 5-6 patients need to be treated early in the ED to prevent 1 hospitalization for acute asthma.
Discussion: Early use of IV or oral corticosteroids should be used for patients seen in the ED with an acute exacerbation of asthma to prevent hospitalization. Further work is required to determine the role of inhaled agents.
Methods: A search of the Airways Review Group data base was conducted to identify randomized placebo controlled trials of corticosteroids for acute asthma. Foreign language and unpublished trials were sought; bibliography searches and author contacts were used. Two reviewers independently reviewed studies for relevance, inclusion, quality scoring, and data extraction.
Results: We identified 9 original publications for inclusion representing 787 patients. The combined estimate of effect showed a benefit to steroid treatment (odds ratio (OR) = 0.36; 95% confidence interval (Cl): 0.19, 0.69). However, this effect was not demonstrated until 4 hours of treatment (4 hours OR: 0.45; 95% Cl: 0.23, 0.86 & 6 hour OR: 0.28: 95% Cl: 0.09, 0.84). This benefit was less pronounced for patients receiving steroid therapy at ED presentation. These results suggest that 5-6 patients need to be treated early in the ED to prevent 1 hospitalization for acute asthma.
Discussion: Early use of IV or oral corticosteroids should be used for patients seen in the ED with an acute exacerbation of asthma to prevent hospitalization. Further work is required to determine the role of inhaled agents.