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'....
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| creator | Normansell, Rebecca Kew, Kayleigh M Mansour, George Normansell, Rebecca |
| description | 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 |
| doi_str_mv | 10.1002/14651858.CD011801.pub2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8504986</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1793565476</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5922-6b77fff99684cf2430cd278300ee53e80025cd9b8e4a59690e2e59aeeb8ace1d3</originalsourceid><addsrcrecordid>eNqFkEtLAzEUhYMovv9CmaWbqUlm8gIRtD5BcKPgLqSZmzYy09RkqvjvnbFWtC5cJXDPOfe7B6EBwUOCMT0mJWdEMjkcXWBCJCbD-WJMN9BuP8j7yebnX-WlKp520F5KzxgXXFGxjXaoIIJzwXeRuPDOQYRZm4Vo6syG2HobUgsx-CqLMPENzFLmQsyMXbSQmdROG3OAtpypExx-vfvo8eryYXST391f347O7nLLFKU5HwvhnFOKy9I6WhbYVlTIAmMAVoDsTmG2UmMJpWGKKwwUmDIAY2kskKrYR6fL3O68BirbgXaYeh59Y-K7Dsbr35OZn-pJeNWS4VJJ3gUcfQXE8LKA1OrGJwt1bWYQFkkToQrGWSl6KV9KbQwpRXDfawjWfet61bpetd4vp51x8BPy27aquROcrCVb35rWh57Z13_zbfU7_3xpf_M1vGsb7DR2-P9grUF-APhZpx8</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1793565476</pqid></control><display><type>article</type><title>Different oral corticosteroid regimens for acute asthma</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Cochrane Library</source><source>Alma/SFX Local Collection</source><creator>Normansell, Rebecca ; Kew, Kayleigh M ; Mansour, George ; Normansell, Rebecca</creator><creatorcontrib>Normansell, Rebecca ; Kew, Kayleigh M ; Mansour, George ; Normansell, Rebecca</creatorcontrib><description>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 participants as the unit of analysis; we analysed continuous data as mean differences (MDs). We used a random‐effects model, and we carried out a fixed‐effect analysis if we detected statistical heterogeneity. We rated all outcomes using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) system and presented results in 'Summary of findings' tables.
Main results
We included 18 studies that randomised a total of 2438 participants ‐ both adults and children ‐ and performed comparisons of interest. Included studies assessed higher versus lower doses of prednisolone (n = 4); longer versus shorter courses of prednisolone (n = 3) or dexamethasone (n = 1); tapered versus non‐tapered courses of prednisolone (n = 4); and prednisolone versus dexamethasone (n = 6). Follow‐up duration ranged from seven days to six months. The smallest study randomised just 15 participants, and the largest 638 (median 93). The varied interventions and outcomes reported limited the number of meaningful meta‐analyses that we could perform.
For two of our primary outcomes ‐ hospital admission and serious adverse events ‐ events were too infrequent to permit conclusions about the superiority of one treatment over the other, or their equivalence. Researchers in the included studies reported asthma symptoms in different ways and rarely used validated scales, again limiting our conclusions. Secondary outcome meta‐analysis was similarly hampered by heterogeneity among interventions and outcome measures used. Overall, we found no convincing evidence of differences in outcomes between a higher dose or longer course and a lower dose or shorter course of prednisolone or dexamethasone, or between prednisolone and dexamethasone.
Included studies were generally of reasonable methodological quality. Review authors assessed most outcomes in the review as having low or very low quality, meaning we are not confident in the effect estimates. The predominant reason for downgrading was imprecision, but indirectness and risk of bias also reduced our confidence in some estimates.
Authors' conclusions
Evidence is not strong enough to reveal whether shorter or lower‐dose regimens are generally less effective than longer or higher‐dose regimens, or indeed that the latter are associated with more adverse events. Any changes recommended for current practice should be supported by data from larger, well‐designed trials. Varied study design and outcome measures limited the number of meta‐analyses that we could perform. Greater emphasis on palatability and on whether some regimens might be easier to adhere to than others could better inform clinical decisions for individual patients.</description><identifier>ISSN: 1469-493X</identifier><identifier>ISSN: 1465-1858</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD011801.pub2</identifier><identifier>PMID: 27176676</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject><![CDATA[Acute Disease ; Administration, Oral ; Adrenal Cortex Hormones ; Adult ; Anti-Asthmatic Agents - administration & dosage ; Anti‐Asthmatic Agents ; Asthma ; Asthma (acute) ; Asthma - drug therapy ; Asthma, acute ‐ pharmacotherapy ; Child ; Child health ; Corticosteroids ; Dexamethasone ; Dexamethasone - administration & dosage ; Glucocorticoids ; Glucocorticoids - administration & dosage ; Hospitalization ; Humans ; Lungs & airways ; Medicine General & Introductory Medical Sciences ; Prednisolone ; Prednisolone - administration & dosage ; Randomized Controlled Trials as Topic ; Steroids, oral and systemic]]></subject><ispartof>Cochrane database of systematic reviews, 2016-05, Vol.2016 (5), p.CD011801-CD011801, Article CD011801</ispartof><rights>Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5922-6b77fff99684cf2430cd278300ee53e80025cd9b8e4a59690e2e59aeeb8ace1d3</citedby><cites>FETCH-LOGICAL-c5922-6b77fff99684cf2430cd278300ee53e80025cd9b8e4a59690e2e59aeeb8ace1d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,777,781,882,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27176676$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Normansell, Rebecca</creatorcontrib><creatorcontrib>Kew, Kayleigh M</creatorcontrib><creatorcontrib>Mansour, George</creatorcontrib><creatorcontrib>Normansell, Rebecca</creatorcontrib><title>Different oral corticosteroid regimens for acute asthma</title><title>Cochrane database of systematic reviews</title><addtitle>Cochrane Database Syst Rev</addtitle><description>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 participants as the unit of analysis; we analysed continuous data as mean differences (MDs). We used a random‐effects model, and we carried out a fixed‐effect analysis if we detected statistical heterogeneity. We rated all outcomes using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) system and presented results in 'Summary of findings' tables.
Main results
We included 18 studies that randomised a total of 2438 participants ‐ both adults and children ‐ and performed comparisons of interest. Included studies assessed higher versus lower doses of prednisolone (n = 4); longer versus shorter courses of prednisolone (n = 3) or dexamethasone (n = 1); tapered versus non‐tapered courses of prednisolone (n = 4); and prednisolone versus dexamethasone (n = 6). Follow‐up duration ranged from seven days to six months. The smallest study randomised just 15 participants, and the largest 638 (median 93). The varied interventions and outcomes reported limited the number of meaningful meta‐analyses that we could perform.
For two of our primary outcomes ‐ hospital admission and serious adverse events ‐ events were too infrequent to permit conclusions about the superiority of one treatment over the other, or their equivalence. Researchers in the included studies reported asthma symptoms in different ways and rarely used validated scales, again limiting our conclusions. Secondary outcome meta‐analysis was similarly hampered by heterogeneity among interventions and outcome measures used. Overall, we found no convincing evidence of differences in outcomes between a higher dose or longer course and a lower dose or shorter course of prednisolone or dexamethasone, or between prednisolone and dexamethasone.
Included studies were generally of reasonable methodological quality. Review authors assessed most outcomes in the review as having low or very low quality, meaning we are not confident in the effect estimates. The predominant reason for downgrading was imprecision, but indirectness and risk of bias also reduced our confidence in some estimates.
Authors' conclusions
Evidence is not strong enough to reveal whether shorter or lower‐dose regimens are generally less effective than longer or higher‐dose regimens, or indeed that the latter are associated with more adverse events. Any changes recommended for current practice should be supported by data from larger, well‐designed trials. Varied study design and outcome measures limited the number of meta‐analyses that we could perform. Greater emphasis on palatability and on whether some regimens might be easier to adhere to than others could better inform clinical decisions for individual patients.</description><subject>Acute Disease</subject><subject>Administration, Oral</subject><subject>Adrenal Cortex Hormones</subject><subject>Adult</subject><subject>Anti-Asthmatic Agents - administration & dosage</subject><subject>Anti‐Asthmatic Agents</subject><subject>Asthma</subject><subject>Asthma (acute)</subject><subject>Asthma - drug therapy</subject><subject>Asthma, acute ‐ pharmacotherapy</subject><subject>Child</subject><subject>Child health</subject><subject>Corticosteroids</subject><subject>Dexamethasone</subject><subject>Dexamethasone - administration & dosage</subject><subject>Glucocorticoids</subject><subject>Glucocorticoids - administration & dosage</subject><subject>Hospitalization</subject><subject>Humans</subject><subject>Lungs & airways</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Prednisolone</subject><subject>Prednisolone - administration & dosage</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Steroids, oral and systemic</subject><issn>1469-493X</issn><issn>1465-1858</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><sourceid>EIF</sourceid><recordid>eNqFkEtLAzEUhYMovv9CmaWbqUlm8gIRtD5BcKPgLqSZmzYy09RkqvjvnbFWtC5cJXDPOfe7B6EBwUOCMT0mJWdEMjkcXWBCJCbD-WJMN9BuP8j7yebnX-WlKp520F5KzxgXXFGxjXaoIIJzwXeRuPDOQYRZm4Vo6syG2HobUgsx-CqLMPENzFLmQsyMXbSQmdROG3OAtpypExx-vfvo8eryYXST391f347O7nLLFKU5HwvhnFOKy9I6WhbYVlTIAmMAVoDsTmG2UmMJpWGKKwwUmDIAY2kskKrYR6fL3O68BirbgXaYeh59Y-K7Dsbr35OZn-pJeNWS4VJJ3gUcfQXE8LKA1OrGJwt1bWYQFkkToQrGWSl6KV9KbQwpRXDfawjWfet61bpetd4vp51x8BPy27aquROcrCVb35rWh57Z13_zbfU7_3xpf_M1vGsb7DR2-P9grUF-APhZpx8</recordid><startdate>20160513</startdate><enddate>20160513</enddate><creator>Normansell, Rebecca</creator><creator>Kew, Kayleigh M</creator><creator>Mansour, George</creator><creator>Normansell, Rebecca</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20160513</creationdate><title>Different oral corticosteroid regimens for acute asthma</title><author>Normansell, Rebecca ; Kew, Kayleigh M ; Mansour, George ; Normansell, Rebecca</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5922-6b77fff99684cf2430cd278300ee53e80025cd9b8e4a59690e2e59aeeb8ace1d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Acute Disease</topic><topic>Administration, Oral</topic><topic>Adrenal Cortex Hormones</topic><topic>Adult</topic><topic>Anti-Asthmatic Agents - administration & dosage</topic><topic>Anti‐Asthmatic Agents</topic><topic>Asthma</topic><topic>Asthma (acute)</topic><topic>Asthma - drug therapy</topic><topic>Asthma, acute ‐ pharmacotherapy</topic><topic>Child</topic><topic>Child health</topic><topic>Corticosteroids</topic><topic>Dexamethasone</topic><topic>Dexamethasone - administration & dosage</topic><topic>Glucocorticoids</topic><topic>Glucocorticoids - administration & dosage</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Lungs & airways</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Prednisolone</topic><topic>Prednisolone - administration & dosage</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Steroids, oral and systemic</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Normansell, Rebecca</creatorcontrib><creatorcontrib>Kew, Kayleigh M</creatorcontrib><creatorcontrib>Mansour, George</creatorcontrib><creatorcontrib>Normansell, Rebecca</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Normansell, Rebecca</au><au>Kew, Kayleigh M</au><au>Mansour, George</au><au>Normansell, Rebecca</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Different oral corticosteroid regimens for acute asthma</atitle><jtitle>Cochrane database of systematic reviews</jtitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2016-05-13</date><risdate>2016</risdate><volume>2016</volume><issue>5</issue><spage>CD011801</spage><epage>CD011801</epage><pages>CD011801-CD011801</pages><artnum>CD011801</artnum><issn>1469-493X</issn><issn>1465-1858</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>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 participants as the unit of analysis; we analysed continuous data as mean differences (MDs). We used a random‐effects model, and we carried out a fixed‐effect analysis if we detected statistical heterogeneity. We rated all outcomes using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) system and presented results in 'Summary of findings' tables.
Main results
We included 18 studies that randomised a total of 2438 participants ‐ both adults and children ‐ and performed comparisons of interest. Included studies assessed higher versus lower doses of prednisolone (n = 4); longer versus shorter courses of prednisolone (n = 3) or dexamethasone (n = 1); tapered versus non‐tapered courses of prednisolone (n = 4); and prednisolone versus dexamethasone (n = 6). Follow‐up duration ranged from seven days to six months. The smallest study randomised just 15 participants, and the largest 638 (median 93). The varied interventions and outcomes reported limited the number of meaningful meta‐analyses that we could perform.
For two of our primary outcomes ‐ hospital admission and serious adverse events ‐ events were too infrequent to permit conclusions about the superiority of one treatment over the other, or their equivalence. Researchers in the included studies reported asthma symptoms in different ways and rarely used validated scales, again limiting our conclusions. Secondary outcome meta‐analysis was similarly hampered by heterogeneity among interventions and outcome measures used. Overall, we found no convincing evidence of differences in outcomes between a higher dose or longer course and a lower dose or shorter course of prednisolone or dexamethasone, or between prednisolone and dexamethasone.
Included studies were generally of reasonable methodological quality. Review authors assessed most outcomes in the review as having low or very low quality, meaning we are not confident in the effect estimates. The predominant reason for downgrading was imprecision, but indirectness and risk of bias also reduced our confidence in some estimates.
Authors' conclusions
Evidence is not strong enough to reveal whether shorter or lower‐dose regimens are generally less effective than longer or higher‐dose regimens, or indeed that the latter are associated with more adverse events. Any changes recommended for current practice should be supported by data from larger, well‐designed trials. Varied study design and outcome measures limited the number of meta‐analyses that we could perform. Greater emphasis on palatability and on whether some regimens might be easier to adhere to than others could better inform clinical decisions for individual patients.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>27176676</pmid><doi>10.1002/14651858.CD011801.pub2</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1469-493X |
| ispartof | Cochrane database of systematic reviews, 2016-05, Vol.2016 (5), p.CD011801-CD011801, Article CD011801 |
| issn | 1469-493X 1465-1858 1465-1858 1469-493X |
| language | eng |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Cochrane Library; Alma/SFX Local Collection |
| subjects | Acute Disease Administration, Oral Adrenal Cortex Hormones Adult Anti-Asthmatic Agents - administration & dosage Anti‐Asthmatic Agents Asthma Asthma (acute) Asthma - drug therapy Asthma, acute ‐ pharmacotherapy Child Child health Corticosteroids Dexamethasone Dexamethasone - administration & dosage Glucocorticoids Glucocorticoids - administration & dosage Hospitalization Humans Lungs & airways Medicine General & Introductory Medical Sciences Prednisolone Prednisolone - administration & dosage Randomized Controlled Trials as Topic Steroids, oral and systemic |
| title | Different oral corticosteroid regimens for acute asthma |
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