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Tuesday, October 16, 2007

Cochrane review: corticosteroids to reduce relapse following asthma exacerbation.

The Cochrane Collaboration has produced a systematic review on the benefit of corticosteroids 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. Researchers evaluated six randomized controlled trials involving 374 people comparing two types of corticosteroids (oral or intramuscular) with placebo for outpatient treatment of asthmatic exacerbations in adults or children. One study used IM corticosteroids, five used oral corticosteroids.

The following results were reported:

· 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 beta2-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.

The authors conclude that “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 beta2-agonist without an apparent increase in side effects. Intramuscular and oral corticosteroids are both effective”.

Cochrane Database of Systematic Reviews 2007 Issue 3

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