Prevention

Consider adding inhaled ^d steroids 

Why?

• A short course of oral steroids reduces relapse and hospital admissions, and patients use less beta-agonists. ^a Inhaled steroids are not clearly as effective. ^d
• Combining oral and inhaled steroids may prevent relapse better than oral steroids alone. ^d There is no clear effect on hospital admissions. ^d
• Side-effects (sore-throat, hoarse voice or nausea) are more common on the combination.  ^a
• Abrupt termination of oral steroids rather than tapered does not cause a significantly worsening of PEFR on stopping or a greater risk of acute exacerbations. ^a

Steroids reduce asthma relapse and hospital admission.

Patient a	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
acute asthma	steroids for 7 to 10 days	no therapy	relapse at 21 days	44%	0.34 (0.14 to 0.82)	4 (3 to 21)
			admission to hospital at 21 days	14%	0.34 (0.13 to 0.89)	11 (8 to 74)

Inhaled and oral steroids cause more adverse effects than oral alone

Patient a	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
acute asthma	oral and inhaled steroids	oral steroids	side-effects at 21 days	52%	29% (1% to 48%)	7 (3 to 120)