Published online: September 12, 2019
Asthma exacerbations are a common and important cause of attendance at emergency departments (ED) and subsequent hospital admission. Standard treatments for acute asthma in the ED include administration of inhaled bronchodilator medications, such as salbutamol to open up the airways, and steroid medication given either intravenously or as a tablet (systemic corticosteroid – SCS) to reduce inflammation in the airways. It is possible that giving inhaled corticosteroid (ICS) medication in addition to standard treatment may be beneficial for patients with an acute asthma attack.
In the recently published article of The Journal of Allergy and Clinical Immunology: In Practice, Kearns and colleagues conducted a systematic review and meta-analyses to determine if the addition of ICS to existing standard treatment with SCS in acute asthma impacted upon the rate of hospitalization from ED. By focusing on the efficacy of ICS as an add-on therapy to SCS, their contemporary findings establish whether the use of ICS achieves additional efficacy to the current practice of administering SCS in acute asthma.
This review included 25 studies involving 2733 participants. There was moderate evidence that high doses of ICS, in addition to SCS, reduced the risk of hospital admission by approximately 27% in ED treatment of moderate-to-severe asthma exacerbations. To put into perspective, the use of ipratropium bromide, a widely used medication for acute asthma in the ED, reduces the risk of hospital admission by approximately 28%. In addition there was moderate evidence of an improvement in clinical scores and vital signs with ICS in addition to SCS. Relatively few studies reported adverse events. The authors propose that ICS can now be recommended for use in addition to SCS in the ED treatment of severe exacerbations of asthma. Further research is required to more accurately determine their optimal role in both the ED and outpatient settings.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.