HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:
Guest Access | Sign In via User Name/Password

This Article Full Text Free Full Text (PDF) Free Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via ISI Web of Science (44) Citing Articles via Google Scholar Google Scholar Articles by Rodrigo, G. Articles by Rodrigo, C. Search for Related Content PubMed PubMed Citation Articles by Rodrigo, G. Articles by Rodrigo, C.

Corticosteroids in the Emergency Department Therapy of Acute Adult Asthma^*

An Evidence-Based Evaluation

^* From the Departamento de Emergencia (Dr. G. Rodrigo), Hospital Central de las FF.AA., Montevideo, Uruguay; and Centro de Tratamiento Intensivo (Dr. C. Rodrigo), Asociación Española Primera de Socorros Mutuos, Montevideo, Uruguay.

Correspondence to: Carlos Rodrigo, MD, Centro de Tratamiento Intensivo, Asociación Española Primera de Socorros Mutuos. Bulevar Artigas 1465, Montevideo 11300, Uruguay; e-mail: gurodrig{at}varela.reu.edu.uy

Objective: To review the literature to determine the benefits of corticosteroids (CCSs) (oral, IM, IV, or inhaled) in the treatment of adult patients with acute asthma presenting at an acute-care setting.

Search strategy: A MEDLINE search was conducted using the following terms: (1) Asthma OR Wheez*, AND (2) Glucocorticoids OR Steroids, AND (3) Acute* OR Emerg. Other sources were the CURRENT CONTENTS database, review articles, reference sections of located studies, and a manual search of the top 15 journals for respiratory and emergency medicine.

Selection criteria: Patients were selected for the study by the following criteria: (1) English language; (2) adult patients with asthma whose acute exacerbations were the primary reason for assessment; (3) involvement in randomized, controlled trials conducted in an emergency care setting; (4) patients had participated in a study investigating a primary research question involving treatment with CCSs; and (5) outcomes based on results of pulmonary function tests and on hospital admission rates.

Results: At the 3-h assessment, only high doses of inhaled CCSs significantly improved pulmonary function compared with placebo (effect size [ES], 0.56; 95% confidence interval [CI], 0.15 to 0.97). On the other hand, after receiving IV CCSs, patients required at least 6 to 24 h to show moderate but nonsignificant improvements of pulmonary function (6-h ES, 0.44 [95% CI, -0.01 to 0.89]; 12-h ES, 0.54 [95% CI, -0.08 to 1.17]; and 24-h ES, 0.53 [95% CI, -0.39 to 1.45]). The data from the six studies that we used to pool information on admission rate outcome showed a 32% reduction in favor of the use of IV CCSs (relative risk [RR], 0.68 [95% CI, 0.47 to 0.99]; number needed to treat, 12.5 [95% CI, 7.1 to 50]). However, the pooled effect of the three high-quality studies showed no difference between groups (RR, 1.21; 95% CI, 0.67 to 2.18). Oral CCSs provided a similarly beneficial effect on pulmonary function when compared with parenteral administration (ES, -0.14; 95% CI, -0.82 to 0.31. Finally, the results showed a nonsignificant favorable trend toward improved outcome with medium or high doses of CCSs.

Conclusions: This evidence-based evaluation suggests that the administration of parenteral CCSs to the patient on arrival at the emergency department (ED) neither improves airflow obstruction nor reduces the need for hospitalization. Parenteral CCSs probably require > 6 to 24 h to begin to act. Comprehensible conclusions about admission rates in the ED setting are difficult to make. At the 3-h assessment, only high doses of inhaled CCSs (in one study) significantly improved pulmonary function compared with placebo. IV and oral CCSs appear to have equivalent effects, and there is a tendency toward improvement in pulmonary function with medium or high doses.

Key Words: acute asthma • corticosteroids • emergency department • evidence-based evaluation • therapeutics

This article has been cited by other articles:

				G J Rodrigo and J A Castro-Rodriguez Anticholinergics in the treatment of children and adults with acute asthma: a systematic review with meta-analysis Thorax, September 1, 2005; 60(9): 740 - 746. [Abstract] [Full Text] [PDF]

				G. J. Rodrigo Comparison of Inhaled Fluticasone with Intravenous Hydrocortisone in the Treatment of Adult Acute Asthma Am. J. Respir. Crit. Care Med., June 1, 2005; 171(11): 1231 - 1236. [Abstract] [Full Text] [PDF]

				R. A. Silverman, R. M. Nowak, P. E. Korenblat, E. Skobeloff, Y. Chen, C. M. Bonuccelli, C. J. Miller, and S. G. Simonson Zafirlukast Treatment for Acute Asthma: Evaluation in a Randomized, Double-Blind, Multicenter Trial Chest, November 1, 2004; 126(5): 1480 - 1489. [Abstract] [Full Text] [PDF]

				R. Buhl and S. G. Farmer Current and Future Pharmacologic Therapy of Exacerbations in Chronic Obstructive Pulmonary Disease and Asthma Proceedings of the ATS, April 1, 2004; 1(2): 136 - 142. [Abstract] [Full Text] [PDF]

				A. K. Nakanishi, A. K. Klasner, and B. K. Rubin A Randomized Controlled Trial of Inhaled Flunisolide in the Management of Acute Asthma in Children Chest, September 1, 2003; 124(3): 790 - 794. [Abstract] [Full Text] [PDF]

				Y Oshita, T Koga, T Kamimura, K Matsuo, T Rikimaru, and H Aizawa Increased circulating 92 kDa matrix metalloproteinase (MMP-9) activity in exacerbations of asthma Thorax, September 1, 2003; 58(9): 757 - 760. [Abstract] [Full Text] [PDF]

				G. Rachelefsky Treating Exacerbations of Asthma in Children: The Role of Systemic Corticosteroids Pediatrics, August 1, 2003; 112(2): 382 - 397. [Abstract] [Full Text] [PDF]

				G. J. Rodrigo and C. Rodrigo Triple Inhaled Drug Protocol for the Treatment of Acute Severe Asthma Chest, June 1, 2003; 123(6): 1908 - 1915. [Abstract] [Full Text] [PDF]

				M. Lee-Wong, F. M. Dayrit, A. R. Kohli, S. Acquah, and P. H. Mayo Comparison of High-Dose Inhaled Flunisolide to Systemic Corticosteroids in Severe Adult Asthma Chest, October 1, 2002; 122(4): 1208 - 1213. [Abstract] [Full Text] [PDF]

				P. E. Marik and J. Varon Oral vs Inhaled Corticosteroids Following Emergency Department Discharge of Patients With Acute Asthma Chest, June 1, 2002; 121(6): 1735 - 1736. [Full Text] [PDF]

				M. L. Edmonds, C. A. Camargo Jr., B. E. Brenner, and B. H. Rowe Replacement of Oral Corticosteroids With Inhaled Corticosteroids in the Treatment of Acute Asthma Following Emergency Department Discharge* : A Meta-analysis Chest, June 1, 2002; 121(6): 1798 - 1805. [Abstract] [Full Text] [PDF]

				B. E. Chipps and D. R. Chipps A Review of the Role of Inhaled Corticosteroids in the Treatment of Acute Asthma Clinical Pediatrics, April 1, 2001; 40(4): 185 - 189. [Abstract] [PDF]

				G. R. Pesola, R. Y. Lin, and R. E. Westfal Corticosteroid Therapy in Acute Asthma Chest, June 1, 2000; 117(6): 1821 - 1822. [Full Text]

				T. K. Lim Corticosteroids in the Emergency Treatment of Acute Severe Asthma Chest, May 1, 2000; 117(5): 1526 - 1527. [Full Text] [PDF]

				G. J. RODRIGO and C. RODRIGO CORTICOSTEROIDS IN ACUTE RESPIRATORY FUNCTION Am. J. Respir. Crit. Care Med., April 1, 2000; 161(4): 1397 - 1398. [Full Text]

				Steroids in Acute Asthma: Oral, IV, or Inhaled? Journal Watch Emergency Medicine, October 1, 1999; 1999(1001): 7 - 7. [Full Text]