Therapy

Why?

• Steroids improve symptoms ^a and reduce hospital admissions if given early, particularly for patients with severe asthma or who are not on steroids. ^a
• Oral corticosteroids are statistically, though not clinically, more effective than iv corticosteroids at improving PEFR and shortening hospital stay. However there is no clear difference in the number of patients developing respiratory failure. ^a
• Inhaled steroids reduce admission to hospital ^a , but are but are not clearly as effective as systemic steroids. ^d  
• The benefits of adding inhaled steroids to systemic steroids are unclear.  ^d

Early steroids reduce hospital admissions

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
asthma exacerbation a	steroids given within 1 hour of arrival in the emergency department	no steroids	hospitalisation at 6 hours	50%	0.50 (0.31 to 0.81)	6 (4 to 19)

Early steroids reduce wheezing

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
admitted with an asthma exacerbation a	iv hydrocortisone	placebo	wheezing at 24 hours	100%	73% (28% to 90%)	1 (1 to 2)

• Doses of < 80 mg methylprednisolone are as effective as higher doses at improving pulmonary function at 48 hours without clearly increasing length of hospital stay. ^a
• Doses of intravenous methylprednisolone ≥ 40 mg given 6 hourly are more effective at improving FEV₁ than 15mg every 6 hours. There appears to be little difference between 40 mg and 125 mg. ^a

Low dose steroids are less effective in improving symptoms.

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
admitted with an asthma exacerbation a	methylprednisolone ≥40 mg every 6 hours	methylprednisolone 15 mg every 6 hours	> 50% predicted FEV1 at 3 days	50%	-100% (-300% to 0%)	2 (1 to 7)