Corticosteroids are currently used routinely in the management of acute severe asthma. The optimal dose and route of administration continues to be debated. Some investigators have reported a greater benefit of higher doses of corticosteroids in the management of severe asthma, while others have not.
To determine whether higher doses of systemic corticosteroids (oral, intravenous or intramuscular) are more effective than lower doses in the management of patients with acute severe asthma requiring hospital admission.
Randomised controlled trials were identified from the Cochrane Airways Group Asthma Register. In addition, primary authors and content experts were contacted to identify eligible studies. Bibliographies from included studies, known reviews and texts were also searched.
Studies were selected for inclusion in the review if they met the following broad inclusion criteria: described as randomised controlled trials, included patients with acute severe asthma, compared different doses of corticosteroids (any route) in 2 or more treatment arms, and had a minimum period of follow up of 24 hours. Two reviewers independently assessed the studies for inclusion and disagreement was resolved by third party adjudication.
Data collection and analysis
Data were extracted independently by two reviewers if the authors were unable to verify the validity of information. Missing data were obtained from authors or calculated from other data presented in the paper. The data were analysed as weighted mean differences (WMD) for primary pulmonary function outcomes using a fixed effects model. For the purposes of the review, three broad categories of corticosteroid dose (equivalent dose of methylprednisolone in 24 hours) were defined in advance: low dose (< or = 80 mg), medium dose (> 80 mg and < or = 360 mg) and high dose (> 360 mg). There were thus 3 main comparison groups: low versus medium dose, medium versus high dose and low versus high dose.
Nine trials were included; a total of 344 adult patients have been studied (96 with low dose, 85 with medium dose and 163 with high dose corticosteroids). Only 6 trials provided sufficient data for the meta-analysis. There were no clinically or statistically significant differences detected in % predicted FEV1 among comparison groups after 24, 48 or 72 hours. At 48 hours, the weighted mean difference was -3.3% predicted (95% confidence interval -12.4 to + 5.8) for the low vs medium dose comparison, -1.9% predicted (95% CI -8.1 to + 4.3) for the medium vs high dose comparison and + 0.5% predicted (95% CI - 7.8 to + 8.8) for the low vs high dose comparison. There appeared to be no significant differences in side effects or rates of respiratory failure among the varying doses of corticosteroids. A further search was conducted in September 2002. No new trials were identified.
No differences were identified among the different doses of corticosteroids in acute asthma requiring hospital admission. Low dose corticosteroids (< or = 80 mg/day of methylprednisolone or < or = 400 mg/day of hydrocortisone) appear to be adequate in the initial management of these adult patients. Higher doses do not appear to offer a therapeutic advantage.
目前使用皮質類固醇治療急性重症氣喘的患者, 被視為常規.最佳的用藥劑量以及途徑仍然在持續的辯論中. 有一些研究人員指出對於患有急性重症病患使用更高的皮質類固醇劑量,會有更好的療效,有些並不然.
從Cochrane Airways Group Asthma Register 選取隨機對照試驗. 搜尋相關的文獻以及已知的教科書,並且聯繫主要文獻作者及專家.
以下是符合納入回顧研究的標準: 隨機對照試驗,包含了患有急性重症氣喘的病患, 2種或2種以上不同劑量的皮質類固醇(任何方法)的比較, 必須有至少於24小時的用藥追蹤.研究的選擇條件分別由2個獨立的審查員所評估,其意見不一致則由第3方裁決.
如果作者無法確認相關數據的效性,則請兩位獨立的審查者萃取數據.遺漏值則經由作者取得，或者從發表的文獻中計算. 數據的分析以加權平均值的方式作為主要肺功能效果測試的模型.作為審查的目的類皮質類固醇的劑量(相當於在24小時內等劑量的甲撥尼龍)可分為3大類: 低劑量(<或 = 80毫克)，中劑量(>80毫克或 = 360毫克)和高劑量(>360毫克). 因此,主要有3組比較:低劑量與中劑量, 中劑量與高劑量, 低劑量與高劑量.
有9個試驗被納入;總共參與研究的人數為344(低劑量96,中劑量85,高劑量163). 只用其中6個試驗經過後設分析後有顯著差異. 在檢測FEV%在各個組別經過24,48或72小時候,臨床上或統計學意義上沒有任何顯著的差異.在48小時內,低劑量與中劑量加權平均差的預測是−3.3%(95%信賴區間在−12.4 – 5.8), 在中劑量與高劑量加權平均差的預測是−1.9%(95%信賴區間在−8.1 – 4.3),在低劑量與高劑量加權平均差的預測是0.5%(95%信賴區間在−7.8 – 8.8). 副作用或呼吸衰竭之間使用不同劑量的皮質類固醇似乎沒有任何顯著的差異. 在2002年9月有更進一步的研究.此外沒有任何新的試驗了.
以不同劑量的皮質類固醇治療需住院之急性重症氣喘病患,效果並沒有差異. 低劑量的皮質類固醇(<或 = 80毫克/天的甲撥尼龍/ <或 = 400毫克/天的氫化可的松) 似乎對成人病患的早期治療是足夠的.更高劑量並沒有更好的療效.
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
低劑量的皮質類固醇,即足以幫助住院的病患緩解氣喘的症狀. 在氣喘發作中,氣道(到肺的通道)縮緊經由肌肉痙攣個腫脹(發炎)會造成呼吸困難,哮鳴,咳嗽.氣喘的發作可是會致命的.藥物(經由吸入,口服,靜脈注射)可用於放鬆肌肉. 類固醇(皮質類固醇)的抗發炎藥物可以減少腫脹.本研文獻回顧發現,氣喘發作入院之起始治療,低劑量與高劑量的皮質類固醇一樣有效.