An Umbrella Review: Corticosteroid Therapy for Adults with Acute Asthma
Abstract
The objective of this “umbrella” review is to synthesize the evidence and provide clinicians a single report that summarizes the state of knowledge regarding the use of corticosteroids in adults with acute asthma. Systematic reviews in the Cochrane Library and additional clinical trials published in English from 1966 to 2007 in MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL, and references from bibliographies of pertinent articles were reviewed. Results indicate that the evidence base is frequently limited to small, single-center studies. Findings suggest that therapy with systemic corticosteroids accelerates the resolution of acute asthma and reduces the risk of relapse. There is no evidence that corticosteroid doses greater than standard doses (prednisone 50-100 mg equivalent) are beneficial. Oral and intravenous corticosteroids, as well as intramuscular and oral corticosteroid regimens, seem to be similarly effective. A nontapered 5- to 10-day course of corticosteroid therapy seems to be sufficient for most discharged patients. Combinations of oral and inhaled corticosteroids on emergency department/hospital discharge might minimize the risk of relapse.
aDepartment of Medicine, University of Chicago, Chicago, Illinois
bDepartment of Health Studies, University of Chicago, Chicago, Illinois
cDepartment of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, Newcastle, Australia
dDepartment of Emergency Medicine, University of Alberta, Canada
Requests for reprints should be addressed to Jerry A. Krishnan, MD, PhD, The University of Chicago, 5841 S. Maryland Ave, MC 6076, Chicago, IL 60637
Funding: Parker B. Francis Fellowship Award and the National Institutes of Health (HL67850); National Health and Medical Research Council (NHMRC) Australia and an NHMRC Practitioner Fellowship award (PG); 21st Century Research Chair Program from the Government of Canada (BHR).
Conflict of Interest: Dr Rowe has received research support and speaker's fees from GlaxoSmithKline (once: $1000) and AstraZeneca (multiple: ∼$3000/year) in the past 3 years; he is not a paid consultant or employee of either. Dr Gibson has received payment for expenses incurred in speaking at educational meetings in symposia sponsored by GlaxoSmithKline, AstraZeneca, and Novartis. Dr Gibson's institution has received research funding for studies from GlaxoSmithKline.
Authorship: All authors had access to the data and played a role in writing this manuscript.
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