Different oral corticosteroid regimens for acute asthma

Background Asthma is a common long‐term breathing condition that affects approximately 300 million people worldwide. People with asthma may experience short‐term worsening of their asthma symptoms; these episodes are often known as ‘exacerbations’, ‘flare‐ups’, ‘attacks’ or 'acute asthma'. Oral steroids, which have a potent anti‐inflammatory effect, are recommended for all but the most mild asthma exacerbations; they should be initiated promptly. The most often prescribed oral steroids are prednisolone and dexamethasone, but current guidelines on dosing vary between countries, and often among different guideline producers within the same country. Despite their proven efficacy, use of steroids needs to be balanced against their potential to cause important adverse events. Evidence is somewhat limited regarding optimal dosing of oral steroids for asthma exacerbations to maximise recovery while minimising potential side effects, which is the topic of this review. Objectives To assess the efficacy and safety of any dose or duration of oral steroids versus any other dose or duration of oral steroids for adults and children with an asthma exacerbation. Search methods We identified trials from the Cochrane Airways Group Specialised Register (CAGR), ClinicalTrials.gov (www.ClinicalTrials.gov), the World Health Organization (WHO) trials portal (www.who.int/ictrp/en/) and reference lists of all primary studies and review articles. This search was up to date as of April 2016. Selection criteria We included parallel randomised controlled trials (RCTs), irrespective of blinding or duration, that evaluated one dose or duration of oral steroid versus any other dose or duration, for management of asthma exacerbations. We included studies involving both adults and children with asthma of any severity, in which investigators analysed adults and children separately. We allowed any other co‐intervention in the management of an asthma exacerbation, provided it was not part of the randomised treatment. We included studies reported as full text, those published as only and unpublished data. Data collection and analysis Two review authors independently screened the search results for included trials, extracted numerical data and assessed risk of bias; all data were cross‐checked for accuracy. We resolved disagreements by discussion with the third review author or with an external advisor. We analysed dichotomous data as odds ratios (ORs) or risk differences (RDs) using study part