- Systemic corticosteroids versus placebo:
- One systematic review (search date 1991, five RCTs, n = 422) found that early intervention with systemic corticosteroids (oral, intravenous, or intramuscular) significantly reduced hospitalizations compared with placebo (OR 0.47, 95% CI 0.27 to 0.79). Another systematic review (five RCTs, n = 345) showed that systemic corticosteroids (oral or intramuscular) significantly reduced the relapse rate at 7–10 days (RR 0.35, 95% CI 0.17 to 0.73; NNT 13) and hospital readmission within 7 days (RR 0.32, 95% CI 0.11 to 0.94; NNT 16) compared with placebo. Corticosteroids also significantly reduced the use of beta2-agonists [Rodolfo et al, 2005].
- A later systematic review (search date September 2000, 12 RCTs, n = 863) of corticosteroids given within 1 hour to people presenting to the emergency department with acute asthma further supports these findings. Early administration of corticosteroids significantly reduced admission rates (11 trials; pooled OR 0.4, 95% CI 0.21 to 0.78; NNT 8, 95% CI 5 to 21), and benefits were more pronounced for people not already receiving systemic corticosteroids and people with more severe asthma. Oral corticosteroids were particularly effective in children (three RCTs) [Rowe et al, 2001].
- Stopping treatment:
- A small RCT (n = 35) of people admitted to hospital for asthma who were given 40 mg of prednisolone over 10 days showed no difference in morning peak expiratory flow rate between tapering over 1 week and abruptly stopping therapy (p = 0.82) [Rodolfo et al, 2005].
- Dose and duration:
- Three small RCTs showed no difference in dose and duration (5–10 days) of corticosteroids with regard to lung function and relapse rates. Nevertheless, all three RCTs may have lacked the power to detect a clinically important difference. The optimum dose and duration is likely to depend on the individual, severity of the exacerbation, and concomitant medication [Rodolfo et al, 2005].
- Corticosteroids in children:
- A systematic review (17 RCTs) showed oral corticosteroids to be effective for outpatient treatment of acute asthma in children. Early administration of oral corticosteroids appeared to reduce hospitalizations [Rachelefsky, 2003].
- A systematic review (search date May 2006, two RCTs, n = 303) showed that when parents initiated oral corticosteroid therapy for an intermittent wheezing illness (asthma, viral wheeze, and preschool viral wheeze), there was no significant benefit in terms of hospital admissions, symptom scores, bronchodilator use, parental and patient impressions, or days lost from school [Vuillermin et al, 2006].
Access Prodigy topics and clinical content at the NICE website.
To arrange a free trial of the Prodigy application, get in touch.
The Prodigy application is available on a subscription basis.