An Umbrella Review: Corticosteroid Therapy for Adults with Acute Asthma

Abstract

The objective of this 'umbrella' review is to synthesize the evidence and provide clinicians a single report which summarizes the state of knowledge regarding the use of corticosteroids in adults with acute asthma. Systematic reviews in the Cochrane Library and additional clinical trials published in English from 1966 to 2007 in MEDLINE, EMBASE, CINAHL, and Cochrane CENTRAL and references from bibliographies of pertinent articles were reviewed. Results indicate that the evidence base is frequently limited to small, single-center studies. Findings suggest that therapy with systemic corticosteroids accelerates resolution of acute asthma and reduces the risk of relapse. There is no evidence that corticosteroid doses higher than standard doses (prednisone 50-100 mg equivalent) are beneficial. Oral and intravenous corticosteroids, as well as intramuscular and oral corticosteroid regimens appear to be similarly effective. A non-tapered 5-10 day course of corticosteroid therapy appears to be sufficient for most discharged patients. Combinations of oral and inhaled corticosteroids on emergency department/hospital discharge may minimize the risk of relapse.

World Allergy Organization anaphylaxis guidelines: Summary

“…Extrapolating from their use in acute asthma, the onset of action of systemic glucocorticoids takes several hours. 125,126 Although they potentially relieve protracted anaphylaxis symptoms and prevent biphasic anaphylaxis, 2,16,22,24,25,32,111 these effects have never been proven (Table 8). A Cochrane systematic review failed to identify any evidence from randomized, controlled trials to confirm the effectiveness of glucocorticoids in the treatment of anaphylaxis, and raised concerns that they are often inappropriately used as first-line medications in place of epinephrine.…”

“…Tables 5, 6, and 8. 2,3,15,16,[21][22][23][24][25]32,[121][122][123][124][125][126][127] H 1 -Antihistamines. In anaphylaxis, H 1 -antihistamines relieve itching, flushing, urticaria, angioedema, and nasal and eye symptoms 111 ; however, they should not be substituted for epinephrine because they are not life-saving; that is, they do not prevent or relieve upper airway obstruction, hypotension, or shock 2,15,22,23,32,96,121 (Table 8).…”

Glucocorticoids target suppressor of cytokine signaling 1 (SOCS1) and type 1 interferons to regulate Toll-like receptor–induced STAT1 activation

“…Most of these cytokines transmit signals through cell surface receptors to the nucleus by engaging a family of latent transcription factors, signal transducer and activator of transcription (STAT), for further initiation, propagation, and resolution of inflammation (7). Defining the regulation of STAT proteins by GC is of particular interest, given that STAT's later temporal activation corresponds to the time when most GC clinical efficacy is displayed (8).…”

Corticosteroids in management of anaphylaxis; a systematic review of evidence

“…They act through modulation of gene expression, and therefore require 4 to 6 hours for the effects to manifest (45). These anti-inflammatory effects are mediated by direct binding of the glucocorticoid / glucocorticoid receptor complex to specific elements in the promoter region of genes, or by interacting with other transcription factors such as the activating protein-1 or nuclear factor-kappa B (40,41,46).…”