Original contribution
Effectiveness of steroid therapy in acute exacerbations of asthma: A meta-analysis

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Abstract

The objective of this study was to determine the effect of steroid therapy on pulmonary function, admission rates, and relapse rates in patients presenting with acute exacerbations of asthma. Computerized MEDLINE and SCIENCE CITATION searches were combined with review of reference lists from book chapters and articles to identify published randomized trials on steroid interventions. Over 700 articles were reviewed by two independent reviewers who identified 30 relevant randomized controlled trials for analysis. Study validity was independently assessed by two reviewers and information regarding populations, interventions, and outcomes was abstracted. Binary outcomes were combined and reported as odds ratios (OR), using the Mantel-Haenszel method. Individual and pooled effect sizes (ES) were determined for pulmonary function data. The authors found that the use of steroids early in the treatment of asthmatic exacerbations reduces admissions in adults (common OR 0.47; 95% confidence interval (CI) 0.27, 0.79) and children (OR 0.06–0.42). They found steroids effective in preventing relapse in the outpatient treatment of asthmatic exacerbations (OR 0.15; CI 0.05, 0.44). Oral and intravenous steroids appear to have equivalent effects on pulmonary function in acute exacerbations (ES −0.07; CI −0.39, 0.25). The authors conclude that overall, steroid therapy provides important benefits to patients presenting to emergency departments with acute exacerbations of asthma. Further research into dosage, alternative routes of administration, and alternative outcome measures is needed.

References (57)

  • IB Hoffman et al.

    Oral vs repository corticosteroid therapy in acute asthma

    Chest

    (1988)
  • AC Raimondi et al.

    Comparison between high and moderate doses of hydrocortisone in the treatment of status asthmaticus

    Chest

    (1986)
  • RM Tanaka et al.

    Intravenous methylprednisolone in adults in status asthmaticus

    Chest

    (1982)
  • GFA Benfield et al.

    Predicting rapid and slow response to treatment in acute severe asthma

    Br J Dis Chest

    (1983)
  • WG Reiss et al.

    Steroid dose sparing: Pharmacodynamic responses to single versus divided doses of methylprednisolone in man

    J Allergy Clin Immunol

    (1990)
  • HM Carryer et al.

    Effects of cortisone on bronchial asthma and hay fever in subjects sensitive to ragweed pollen

  • Medical Research Council Subcommittee on clinical trials in asthma

    Controlled trial of effects of cortisone acetate in status asthmaticus

    Lancet

    (1956)
  • R Patterson et al.

    Prednisonephobia

  • LM Stein et al.

    Early administration of corticosteroids in emergency room treatment of acute asthma

    Arch Intern Med

    (1990)
  • JV Collins et al.

    The use of corticosteroids in the treatment of acute asthma

    Q J Med

    (1975)
  • AD Oxman et al.

    Guidelines for reading literature reviews

    Can Med Assoc J

    (1988)
  • British Thoracic Society

    Guidelines for management of asthma in adults. II. Acute severe asthma

    Br Med J

    (1990)
  • KF Chung

    Inflammatory mediators in asthma

  • PM O'Byrne

    Airway inflammation and asthma

  • RW Fuller et al.

    Mechanisms of asthma, bronchial hyperresponsiveness and action of glucocorticoids in asthma

  • WE Pierson et al.

    A double-blind trial of corticosteroid therapy in status asthmaticus

    Pediatrics

    (1974)
  • MS Kramer et al.

    Clinical biostatistics. LIV. The biostatistics of concordance

    Clin Pharmacol Therap

    (1981)
  • GV Glass
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