Intervention Review

Early emergency department treatment of acute asthma with systemic corticosteroids

  1. Brian H Rowe1,*,
  2. Carol Spooner2,
  3. Francine Ducharme3,
  4. Jennifer Bretzlaff4,
  5. Gary Bota4

Editorial Group: Cochrane Airways Group

Published Online: 22 JAN 2001

Assessed as up-to-date: 23 SEP 2002

DOI: 10.1002/14651858.CD002178

How to Cite

Rowe BH, Spooner C, Ducharme F, Bretzlaff J, Bota G. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database of Systematic Reviews 2001, Issue 1. Art. No.: CD002178. DOI: 10.1002/14651858.CD002178.

Author Information

  1. 1

    University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada

  2. 2

    1G1.52 Walter Mackenzie Health Centre, Division of Emergency Medicine, Edmonton, Alberta, Canada

  3. 3

    McGill University Health Centre, Department of Pediatrics, Montreal, Quebec, Canada

  4. 4

    Sudbury Regional Hospital, St Joseph's Site, Sudbury, Ontario, Canada

*Brian H Rowe, Department of Emergency Medicine, University of Alberta, Room 1G1.43 Walter C. Mackenzie Health Sciences Centre, 8440 112th Street, Edmonton, Alberta, T6G 2B7, Canada. brian.rowe@ualberta.ca.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 22 JAN 2001

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The airway edema and secretions associated with acute asthma are most effectively treated with anti-inflammatories such as corticosteroids delivered by inhaled, oral, intravenous or intra-muscular routes. There is an unresolved debate about the use of systemic corticosteroids in the early treatment of acute asthma for emergency department patients.

Objectives

To determine the benefit of treating patients with acute asthma with systemic corticosteroids within an hour of presenting to the emergency department (ED).

Search methods

Randomised controlled trials were identified from the Cochrane Airways Group Asthma Register. Primary authors and content experts were contacted to identify eligible studies. Bibliographies from included studies and known reviews were searched.

Selection criteria

Only randomised controlled trials (RCTs) or quasi-randomised trials were eligible for inclusion. Studies were included if patients presenting to the ED with acute asthma were treated with IV/IM or oral corticosteroids (CS) versus placebo within 1 hour of arrival and either admission rate or pulmonary function results were reported.

Data collection and analysis

Trial selection, data extraction and quality assessment were carried out independently by two reviewers, and confirmed with corresponding authors.

Main results

Twelve studies involving 863 patients (435 corticosteroids; 428 placebo) were included. Early use of CS for acute asthma in the ED significantly reduced admission rates (N = 11; pooled OR: 0.40, 95% CI: 0.21 to 0.78). This would correspond with a number needed to treat of 8 (95% CI: 5 to 21). This benefit was more pronounced for those not receiving systemic CS prior to ED presentation (N = 7; OR: 0.37, 95% CI: 0.19 to 0.70) and those with more severe asthma (N = 7; OR: 0.35, 95% CI: 0.21 to 0.59). Oral CS therapy in children was particularly effective (N = 3; OR: 0.24, 95% CI: 0.11 to 0.53); no trials in adults used the oral route. Side effects were not significantly different between corticosteroid treatments and placebo.

An update search conducted in September 2002 did not yield any further trials.

Authors' conclusions

Use of corticosteroids within 1 hour of presentation to an ED significantly reduces the need for hospital admission in patients with acute asthma. Benefits appear greatest in patients with more severe asthma, and those not currently receiving steroids. Children appear to respond well to oral steroids.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Early emergency department treatment of acute asthma with systemic corticosteroids

In an asthma attack, the airways (passages to the lungs) narrow from muscle spasms and swelling (inflammation). Bronchodilators (reliever inhalers to open up the lungs and airways) can be used for the spasms, and corticosteroids for the swelling. Corticosteroids can be inhaled, or taken by mouth (orally) or through a drip into the veins (intravenously). The review of trials found that systemic (oral or intravenous) corticosteroids reduce the need for people with asthma attacks to stay in hospital, with few adverse effects.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

在急診室及早使用全身性皮質類固醇治療急性氣喘

與急性氣喘有關的氣道水腫和分泌物,施以抗發炎治療最有效,例如,以吸入、口服、靜脈注射或肌肉注射等途徑給予皮質類固醇。在急診室對急性氣喘患者,是否該儘早使用全身性皮質類固醇治療?目前仍有爭議。

目標

急性氣喘患者,到急診室的一個小時內,使用全身性皮質類固醇治療的效益。

搜尋策略

從Cochrane Airways Group Asthma Register找出隨機對照試驗。並連絡第一作者和其他專家,找出更多合適的研究。同時搜尋所納入的研究及回顧的參考書目。

選擇標準

只納入隨機對照試驗或類隨機對照試驗。所納入的的研究對象為:因急性氣喘發作到急診室的病人,在抵達一個小時內,使用靜脈/肌肉注射或口服皮質類固醇治療,與安慰劑比較;同時要有住院率或肺功能結果的報告。

資料收集與分析

兩位審查員分別進行研究的選取、數據的整理和品質的評估,並與通訊作者確認。

主要結論

共納入十二個研究、863位病患(435位皮質類固醇、428位安慰劑)。在急診室儘早使用全身性皮質類固醇治療急性氣喘可以顯著降低住院率(N = 11;整體危險對比值[OR]:0.40,95%信賴區間:0.21? – 0.78)。相當於益一需治數(NNT)為8(95%信賴區間:5到21)。此效益對於那些到急診室前未使用全身性皮質類固醇者(N = 7;危險對比值:0.37,95%信賴區間:0.19到0.70)以及那些更嚴重的氣喘患者(N = 7;危險對比值:0.35,95%信賴區間:0.21到0.59)效果更為顯著;口服皮質類固醇對兒童特別有效(N = 3;危險對比值:0.24,95%信賴區間0.11到0.53);沒有成人口服的研究。在副作用方面,皮質類固醇治療和安慰劑間沒有顯著差異。2002年9月再次搜尋,沒有找到進一步的研究。

作者結論

對急性氣喘患者,抵達急診室1小時內使用皮質類固醇,顯著降低住院需求。病情更嚴重的氣喘患者和目前沒有接受類固醇治療者患,效益最顯著。兒童對口服類固醇反應良好。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

一到醫院急診室就給予口服或靜脈注射類固醇,可以減少急性氣喘發作患者的住院需求。氣喘發作時,氣道(到肺臟的通道)因肌肉攣縮和腫脹(發炎) 而變窄。支氣管擴張劑(具紓解功能的吸入劑打開肺臟和呼吸道)治療攣縮,皮質類固醇治療腫脹。皮質類固醇可以吸入、可以口服、也可以靜脈滴注。本回顧發現:全身性皮質類固醇(口服或靜脈注射)降低氣喘發作患者的住院需求,且副作用很少。