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Meta-Analysis
. 2007 Jul 18;2007(3):CD000195.
doi: 10.1002/14651858.CD000195.pub2.

Corticosteroids for preventing relapse following acute exacerbations of asthma

B H Rowe  1 , C H Spooner, F M Ducharme, J A Bretzlaff, G W Bota
Affiliations
Meta-Analysis

Corticosteroids for preventing relapse following acute exacerbations of asthma

B H Rowe et al. Cochrane Database Syst Rev. .

Abstract

Background: Acute asthma is responsible for many emergency department (ED) visits annually. Between 12 to 16% will relapse to require additional interventions within two weeks of ED discharge. Treatment of acute asthma is based on rapid reversal of bronchospasm and reducing airway inflammation.

Objectives: To determine the benefit of corticosteroids (oral, intramuscular, or intravenous) for the treatment of asthmatic patients discharged from an acute care setting (i.e. usually the emergency department) after assessment and treatment of an acute asthmatic exacerbation.

Search strategy: We searched the Cochrane Airways Group Specialised Register and reference lists of articles. In addition, authors of all included studies were contacted to locate unpublished studies. The most recent search was run in October 2006.

Selection criteria: Randomized controlled trials comparing two types of corticosteroids (oral, intra-muscular, or inhaled) with placebo for outpatient treatment of asthmatic exacerbations in adults or children.

Data collection and analysis: Two review authors independently assessed trial quality and extracted data. Study authors were contacted for additional information.

Main results: Six trials involving 374 people were included. One study used intramuscular corticosteroids, five studies used oral corticosteroids. The review was split into two reviews and although the latest search yielded no additional placebo controlled trials an additional IM study was included. Significantly fewer patients in the corticosteroid group relapsed to receive additional care in the first week (Relative risk (RR) 0.38; 95% confidence interval (CI) 0.2 to 0.74). This favourable effect was maintained over the first 21 days (RR 0.47; 95% CI 0.25 to 0.89) and there were fewer subsequent hospitalizations (RR 0.35; 95% CI 0.13 to 0.95). Patients receiving corticosteroids had less need for beta(2)-agonists (mean difference (MD) -3.3 activations/day; 95% CI -5.6 to -1.0). Changes in pulmonary function tests (SMD 0.045; 95% CI -0.47 to 0.56) and side effects (SMD 0.03; 95% CI -0.38 to 0.44) in the first 7 to 10 days, while rarely reported, showed no significant differences between the treatment groups. Statistically significant heterogeneity was identified for the side effect results; all other outcomes were homogeneous. From these results, as few as ten patients need to be treated to prevent relapse to additional care after an exacerbation of asthma.

Authors' conclusions: A short course of corticosteroids following assessment for an asthma exacerbation significantly reduces the number of relapses to additional care, hospitalizations and use of short-acting beta(2)-agonist without an apparent increase in side effects. Intramuscular and oral corticosteroids are both effective.

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Conflict of interest statement

Drs. Rowe and Ducharme has received some research grant and consulting fees from GlaxoSmithKline and AstraZeneca, both of whom produce inhaled corticosteroid preparations. The authors of this review were not involved in the original studies included in this review and have no financial or other links to corporations who manufacture corticosteroids.

Figures

1
1
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
2
2
Forest plot of comparison: 1 Oral or Intramuscular corticosteroid (CS) versus placebo, outcome: 1.1 Relapse rates.
3
3
Ten patients need to be treated with corticosteroids to prevent one relapse.
4
4
Eleven patients need to be treated with corticosteroids to prevent on subsequent hospital admission.
1.1
1.1. Analysis
Comparison 1 Oral or Intramuscular corticosteroid (CS) versus placebo, Outcome 1 Relapse rates.
1.2
1.2. Analysis
Comparison 1 Oral or Intramuscular corticosteroid (CS) versus placebo, Outcome 2 PFTs 2‐3 days.
1.3
1.3. Analysis
Comparison 1 Oral or Intramuscular corticosteroid (CS) versus placebo, Outcome 3 PFTs 7‐10 days.
1.4
1.4. Analysis
Comparison 1 Oral or Intramuscular corticosteroid (CS) versus placebo, Outcome 4 Admissions to hospital.
1.5
1.5. Analysis
Comparison 1 Oral or Intramuscular corticosteroid (CS) versus placebo, Outcome 5 Beta‐agonist use.
1.6
1.6. Analysis
Comparison 1 Oral or Intramuscular corticosteroid (CS) versus placebo, Outcome 6 Side effects.
1.7
1.7. Analysis
Comparison 1 Oral or Intramuscular corticosteroid (CS) versus placebo, Outcome 7 High Quality Studies (Relapse Rates).
2.1
2.1. Analysis
Comparison 2 Oral corticosteroids versus placebo, Outcome 1 Relapse rates.
2.2
2.2. Analysis
Comparison 2 Oral corticosteroids versus placebo, Outcome 2 PFTs.
3.1
3.1. Analysis
Comparison 3 Intramuscular corticosteroids versus placebo, Outcome 1 Relapse rates.
3.2
3.2. Analysis
Comparison 3 Intramuscular corticosteroids versus placebo, Outcome 2 PFTs.
See this image and copyright information in PMC

Update of

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