Review: inhaled corticosteroids reduce hospital admission and increase discharge rate during the first 4 hours in the emergency department for acute asthma

doi:10.1136/ebm.12.3.75

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Evidence-Based Medicine 2007;12:75; doi:10.1136/ebm.12.3.75
Copyright © 2007 by the BMJ Publishing Group Ltd.

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Therapeutics

Review: inhaled corticosteroids reduce hospital admission and increase discharge rate during the first 4 hours in the emergency department for acute asthma

Rodrigo GJ. Rapid effects of inhaled corticosteroids in acute asthma: an evidence-based evaluation. Chest 2006;130:1301–11.[CrossRef][Medline]

Q In children and adults with acute asthma, are inhaled corticosteroids (ICSs) more effective than placebo or systemic corticosteroids (SCSs) for clinical outcomes during the first 4 hours in the emergency department (ED)?

Clinical impact ratings GP/FP/Primary care $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ IM/Ambulatory care $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Emergency medicine $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Respirology $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Paediatrics (general) $*$ $*$ $*$ $*$ $*$ $*$ ${star}$

Key Words: adrenal cortex hormones • asthma

The first 150 words of the full text of this article appear below.

METHODS
Data sources: Medline (1966 to February 2006), EMBASE/Excerpta Medica (1974to February 2006), Cochrane Central Register of Controlled Trials(issue 1, 2006), references of included studies and reviews,hand searching of top 20 respiratory and emergency care journals,and unpublished data.

Study selection and assessment: randomised controlled trials (RCTs) in any language that comparedICSs (beclomethasone, dexamethasone, flunisolide, budesonide,or fluticasone) with placebo or SCSs, added to a ß₂agonist; or compared ICSs plus SCSs with SCSs, added to a ß₂agonist in children or adults with acute asthma. 17 RCTs (n= 1133, age $>=$ 6 mo, 59% children) met the selection criteria.Individual study quality was assessed using the Jadad criteria.

Outcomes: hospital admission and ED discharge rate. Secondary outcomesincluded spirometric measures (peak expiratory flow [PEF] andforced expiratory volume in 1 second [FEV₁]) and side effects.

MAIN RESULTS
Compared with placebo or SCSs, ICSs led to fewer hospital . . . [Full text of this article]

Louis-Philippe Boulet, MD

Hôpital Laval,
Quebec City, Quebec, Canada