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Evidence summaries

Inhaled Steroids in Acute Asthma Following Emergency Department Discharge

High dose ICS therapy does probably not provide added benefit to oral corticosteroids following emergency department discharge. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 12 studies. Three trials (n=909) comparing inhaled corticosteroids (ICS) with oral corticosteroids to oral corticosteroids (CS) alone showed no significant benefit from adding ICS to CS. Relapses were reduced, but not significantly (OR 0.68, 95% CI 0.46 to 1.02). No differences were observed between the two groups for relapses requiring admission, quality of life, symptom scores, or adverse effects. Nine trials, involving a total of 1296 patients, compared ICS alone to CS alone. Results showed no differences for relapse rates (OR 1.00, 95% CI 0.66 to 1.52). However, severe asthmatics were excluded from these trials. The results on ICS + CS Vs ICS alone do not apply to young children, since none of the studies involved patients from this age group.

Comment: The quality of evidence is downgraded by sparse data and indirectness (most asthmatics are continuously on inhaled steroids, so that inhaled steroids are always part of their medication).

    References

    • Edmonds ML, Milan SJ, Brenner BE et al. Inhaled steroids for acute asthma following emergency department discharge. Cochrane Database Syst Rev 2012;(12):CD002316. [PubMed].

Primary/Secondary Keywords