Objective: To determine the effectiveness of steroids for the treatment of asthmatic patients discharged from an acute care setting with an asthmatic exacerbation.

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 Foreign language and unpublished trials were sought; bibliography searches and author contacts were used.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: A search of 169 (73%) original publications identified 7 studies for inclusion (k =0.76). Significantly fewer patients in the corticosteroid group relapsed to receive additional care in the first week (odds ratio (OR) = 0.35; 95% confidence interval (CI): 0.17,0.73). In addition, corticosteroids use resulted in fewer hospital admissions (OR: 0.32; 95% CI: 0.11, 0.94). Patients receiving corticosteroids had less need for beta-agonists (weighted mean difference (WMD) = -3.3 activations /d; 95% Cl: -5.6, -1.0). 9 patients need to be treated to prevent 1 relapse after an exacerbation of asthma.

Discussion: A short course of corticosteroids should be used for patients discharged from care after an acute exacerbation of asthma. Oral steroids are preferable to IM, and further work is required to determine the role of inhaled agents.