Asthma: corticosteroids decrease hospital admission.

Clinical bottom line (level 1a)

  1. Adults with acute exacerbations of asthma who are given corticosteroids, are less likely to be admitted to hospital than those given placebo (NNT = 13 at unknown) .
  2. There is no clear difference in lung function at 24 hours between those given corticosteroids and those given placebo.
Rodrigo and Rodrigo: Chest 1999; 116 (2): 285-295
Expires November 2002

The study

Systematic review of randomised controlled trials set in an emergency care setting of
  • Patients: adults with acute exacerbations of asthma
  • Intervention: glucocorticoids compared with placebo
  • Outcome: airflow obstruction and need for hospitalisation


    • Articles found in English using MEDLINE, CURRENT CONTENTS, 1966 to October 1998 (search terms: MeSH terms: asthma OR wheez*, AND glucocorticoids OR steroids, AND acute* OR emerg* ) and Hand searching of a previous meta-analysis, review articles, the reference sections of located studies, and searching the top fifteen journals in respiratory care and emergency medicine.

    Selection criteria: as above
    Appraisal criteria: detailed in text
    Articles excluded if: patients with chronic airflow limitation, patients <18 years old

    16 trials were included.
    • The mean age of patients involved was 32 years.

    The evidence

    Outcome Time to outcome CER RR
    (95% CI)    		 NNT
    (95% CI)
    hospital admission unknown 61/241
    (25.3%)    		 0.68
    (0.47 to 0.99)     		13
    (8 to 400)

    • The mean difference in lung function at 24 hours was 0.53 (95% CI: -0.39 to 1.45).

    Comments

    1. Parenteral corticosteroids probably require >6 to 24 hours to begin to act.
    2. Overall, the effect did not depend on the route of administration

    Citation

    1. Rodrigo G, and Rodrigo C: Corticosteroids in the emergency department therapy of acute adult asthma: An evidence-based evaluation. Chest 1999; 116 (2): 285-295
    Contributor: Clare Wotton and Arturo-Marti Carvajal, February 2000
    Reviewer: Mitsuhiro Kamei

    Clinical Question.
    Patient adults with asthma
    Intervention or Exposure corticosteroids
    Comparison placebo
    Outcome hospitalisation