title: Early emergency department treatment of acute asthma with systemic corticosteroids.
abstract: 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 corticorticoids in the early treatment of acute asthma for emergency department patients.
  
  
  OBJECTIVE
  To determine the benefit of treating patients with acute asthma with systemic corticosteroids within an hour of presenting to the emergency department (ED).
  
  
  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.
  
  
  METHODS
  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) vs. placebo within 1 hour of arrival and either admission rate or pulmonary function results were reported.
  
  
  METHODS
  Trial selection, data extraction and quality assessment were carried out independently by two reviewers, and confirmed with corresponding authors.
  
  
  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.
  
  
  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.
authors.affiliation: Division of Emergency Medicine, University of Alberta, 1G1 Walter Mackenzie Centre, 8440-112 Street, Edmonton, Alberta, Canada, T6G 2B7. Brian.Rowe@gpu.srv.ualberta.ca
authors.forename: B H
authors.initials: BH
authors.lastname: Rowe
authors.forename: C
authors.initials: C
authors.lastname: Spooner
authors.forename: F M
authors.initials: FM
authors.lastname: Ducharme
authors.forename: J A
authors.initials: JA
authors.lastname: Bretzlaff
authors.forename: G W
authors.initials: GW
authors.lastname: Bota
mesh_terms: D000208:Acute Disease; D001249:Asthma / Q000188:drug therapy*; D004632:Emergency Medical Services; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans
chemical_list: D005938:Glucocorticoids