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.
To determine the benefit of treating patients with acute asthma with systemic corticosteroids within an hour of presenting to the emergency department (ED).
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.
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.
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.
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.
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。
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。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。