Littenberg and Gluck initially showed that they decrease hospital admission rate. Rodrigo and Rodrigo reviewed all these six studies and concluded that there was no improvement in hospital admission rate or lung function.
Hence, data in terms of lung function are more encouraging. On the other hand, Krishnan et al. For example, Marquette et al. Nine trials were included with a total patients' number of adults.
They found no difference between the different doses. Studies also showed no difference in the efficacy or onset of action between oral and IV administration. Fifty-two adults with severe acute asthma were treated with either IV hydrocortisone or prednisolone.
There was no difference in their peak flow measurements 24 h after admission. GINA and the EPR3 guidelines prefer oral administration because it is less invasive except in patients with absorption problems or those who are not able to take orally due to the severity of their respiratory distress or because they are vomiting.
Prescribing a short course of oral corticosteroids following the ED treatment of acute asthma exacerbations was found to reduce the rate of relapse.
The use of ICS in the treatment of acute asthma was studied in four contexts:. As add on therapy to systemic steroids with continuation after discharge from the ED, or. In addition, a recent study found that preemptive use of high dose fluticasone mcg BID at the onset of an upper respiratory tract infection in children with recurrent virus induced wheezing and continuing it for 10 days, reduced the use of rescue oral corticosteroids.
When ICSs were compared with systemic corticosteroids in randomized and blinded studies the conclusions were conflicting. Some studies reported superiority of systemic steroids in reducing admission rate,[ 58 ] some reported equal efficacy in relation to admission rate as well,[ 59 , 60 , 61 ] and some reported superiority of ICS.
Inhaled corticosteroids were also used as add on therapy to systemic corticosteroids in the ED and continued after discharge. In this context, Rowe et al.
There are few randomized and blinded studies examining only the short-term effect of ICS in the ED as add on therapy to systemic corticosteroids plus other standard acute asthma therapy. One study looked at the addition of high dose beclomethasone versus placebo to methylprednisolone in 60 adults and found no difference in FEV 1 or symptoms between the two groups.
However, the patient number included was very small and PEFR is generally not reliable in young children. Both groups had no difference in the pulmonary index score. In the other study by Upham et al. There was no difference in the asthma score[ 25 ] at 2 h after intervention or in the admission rate or time to discharge from the ED between the two groups.
Collectively, it was hard to come up with a conclusion from these studies about whether adding ICS to systemic steroids in standard acute asthma therapy will add more benefit or not. Therefore, we recently performed a larger blinded and randomized study to look at this question. However, when we looked at only the subgroup with severe acute asthma, budesonide was able to significantly decrease the admission rate of those patients and to lower their asthma score, suggesting an added value.
More large trials specifically targeting patients with severe acute asthma are clearly needed. Corticosteroids play an important role in the treatment of acute asthma exacerbations in the ED as well as post discharge from the ED. Further research is greatly needed to shed more light on the use of ICS in those patients, their optimal dose and duration, as well as their concomitant use with systemic corticosteroids.
In addition, more research is needed on the safety of dispensing oral corticosteroids for home use in case of asthma exacerbation. The author holds exclusive copyright to this chapter.
Grant number MED Conflict of Interest: None declared. National Center for Biotechnology Information , U. Journal List Ann Thorac Med v. Ann Thorac Med. Abdullah A. Author information Article notes Copyright and License information Disclaimer. Address for correspondence: Dr. Box , Riyadh , Saudi Arabia.
E-mail: as. Received Dec 9; Accepted Mar This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3. This article has been cited by other articles in PMC. Abstract Asthma is a prevalent chronic disease of the respiratory system and acute asthma exacerbations are among the most common causes of presentation to the emergency department ED and admission to hospital particularly in children.
Keywords: Acute asthma, emergency department, inhaled corticosteroids, systemic corticosteroids. Pathophysiology of Acute Asthma: Brief Overview Asthma is a chronic respiratory disease that is prevalent worldwide.
Open in a separate window. Introduction and Evolution of Corticosteroids in the Management of Asthma: Historical Background Shortly after the discovery of the structure of adrenal steroid hormones, Hench et al.
Table 2 Common types of systemic corticosteroids and their relative properties. Clinical Evidence of the Effect of Corticosteroids in Acute Asthma Systemic corticosteroids Systemic corticosteroids given early in the course of treatment of acute asthma exacerbations in the ED were overall shown to be effective and are recommended by different asthma guidelines like GINA and EPR3.
Inhaled corticosteroids The use of ICS in the treatment of acute asthma was studied in four contexts: In comparison to placebo, In comparison to systemic corticosteroids, As add on therapy to systemic steroids with continuation after discharge from the ED, or As add on therapy to systemic steroids within the ED stay period only.
Conclusion Corticosteroids play an important role in the treatment of acute asthma exacerbations in the ED as well as post discharge from the ED. References 1. Asthma: Epidemiology, etiology and risk factors. Effect of bronchoconstriction on airway remodeling in asthma. N Engl J Med. Remodeling in asthma. Proc Am Thorac Soc. Holgate ST. Pathogenesis of asthma. Clin Exp Allergy. Asthma exacerbations: Origin, effect, and prevention. J Allergy Clin Immunol. Prevalence of viral respiratory tract infections in children with asthma.
Relationship of viral infections to wheezing illnesses and asthma. Nat Rev Immunol. Prednisone can be a huge help for people like Carmen Spence, 30, of Louisville, Ky.
When she can't get relief from her inhaler and her peak flow the measurement of exhaled air readings drop, she reaches for prednisone. I usually notice an improvement within a day of starting prednisone and am feeling much better within just a few days," says Spence. As a short-term treatment — often between 10 to 14 days — prednisone is very effective in managing asthma symptoms and causes few treatment side effects, but that changes when used over the long term.
Prednisone has too many side effects to use it every day to keep asthma symptoms under control. Long term, the treatment side effects of prednisone become more serious. Risks and side effects of long-term prednisone use include:. But at the same time, your need for it should be carefully evaluated. The side effects of long-term use of oral steroids can include:. If a doctor does prescribe long-term steroids, a person should never suddenly stop taking them.
Doing so can cause symptoms, including dizziness, thirst, and vomiting. Instead, they may need to reduce the dosages slowly before stopping completely. Usually, doctors do not prescribe prednisone alone for the treatment of asthma. Instead, they often prescribe prednisone alongside other medicines. One example is beta-2 agonists, such as albuterol, which can reduce airway constriction that occurs in an asthma attack. Another example is ipratropium, a medication that is administered with a nebulizer or inhaler.
Ipratropium causes smooth muscle or airway relaxation to help a person breathe more easily. Doctors can also administer intravenous steroids if an individual cannot take oral steroids. Examples include intravenous hydrocortisone and methylprednisolone.
In addition to medications, people can help manage their asthma by avoiding triggers that can include:. When a person has asthma, the goal is to help control their attacks so that they are infrequent or do not occur at all. Signs that indicate someone should see a doctor about managing their asthma include:. Many different medications are available to treat asthma. Doctors may need to try different combinations of these medicines to work out what will be most effective for a person.
Prednisone is a short-term medication option to help children and adults who have experienced acute asthma exacerbations. While long-term steroid use can be concerning, short-term use does not typically cause unwanted side effects.
Ideally, a person can adjust their medications and asthma treatment plan after a significant asthma attack to reduce the likelihood of one happening again. Read the article in Spanish. Prednisone is a steroid people use to treat autoimmune disorders, but it can also affect how the body reacts to insulin.
This can be a contributing…. Many people with asthma wonder whether inhalers are still safe to use after their expiry dates. Here, learn about expiration, risks, and more.
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