Early use of inhaled corticosteroids in the emergency department treatment of acute asthma

Abstract

Trusted evidence. Informed decisions. Better health.

Adding nebulized corticosteroids to systemic corticosteroids for acute asthma in children: A systematic review with meta‐analysis

“…In terms of lung function, only two studies (one in the ED and one in hospitalized children) reported this outcome, and in both, children on ICS + SC significantly improved the PEFR in comparison with SC. The same result was previously described in adults using PEFR, but not with FEV1 8 . Similarly, the present review shows that adding budesonide to SC does not result in more AEs or SAEs, as was described in the last Cochrane review 8 …”

“…The same result was previously described in adults using PEFR, but not with FEV1 8 . Similarly, the present review shows that adding budesonide to SC does not result in more AEs or SAEs, as was described in the last Cochrane review 8 …”

“…8 Similarly, the present review shows that adding budesonide to SC does not result in more AEs or SAEs, as was described in the last Cochrane review. 8 The most recent GINA guidelines 4 stated that a high dose of ICS within the first hours after presentation to ED reduces the need for hospitalization in patients who do not receive SC, but the addition of ICS to SC was inconclusive, and the type of ICS, doses, and duration remained unclear; moreover, the cost is an issue that remains to be resolved. Likewise, the latest Cochrane review 8 of five studies (n = 433 patients), but only two studies 20,23 in children, showed that ICS plus SC significantly reduces hospital admission compared with SC, but with high heterogenicity (OR = 0.54 [0.36-0.81], I 2 = 52%), and stated the necessity for further research "to clarify the most appropriate drug dosage and delivery device, and to define which patients are most likely to benefit from ICS therapy."…”

Adding nebulized corticosteroids to systemic corticosteroids for acute asthma in children: A systematic review with meta‐analysis

“…In terms of lung function, only two studies (one in the ED and one in hospitalized children) reported this outcome, and in both, children on ICS + SC significantly improved the PEFR in comparison with SC. The same result was previously described in adults using PEFR, but not with FEV1 8 . Similarly, the present review shows that adding budesonide to SC does not result in more AEs or SAEs, as was described in the last Cochrane review 8 …”

“…The same result was previously described in adults using PEFR, but not with FEV1 8 . Similarly, the present review shows that adding budesonide to SC does not result in more AEs or SAEs, as was described in the last Cochrane review 8 …”

“…8 Similarly, the present review shows that adding budesonide to SC does not result in more AEs or SAEs, as was described in the last Cochrane review. 8 The most recent GINA guidelines 4 stated that a high dose of ICS within the first hours after presentation to ED reduces the need for hospitalization in patients who do not receive SC, but the addition of ICS to SC was inconclusive, and the type of ICS, doses, and duration remained unclear; moreover, the cost is an issue that remains to be resolved. Likewise, the latest Cochrane review 8 of five studies (n = 433 patients), but only two studies 20,23 in children, showed that ICS plus SC significantly reduces hospital admission compared with SC, but with high heterogenicity (OR = 0.54 [0.36-0.81], I 2 = 52%), and stated the necessity for further research "to clarify the most appropriate drug dosage and delivery device, and to define which patients are most likely to benefit from ICS therapy."…”

Controlled Trial of Budesonide–Formoterol as Needed for Mild Asthma

“…The findings of our trial are consistent with evidence regarding the treatment of moderate and severe asthma -that maintenance and reliever therapy with inhaled glucocorticoid-formoterol results in a lower risk of severe exacerbations than maintenance therapy with an inhaled glucocorticoid-LABA and as-needed SABA 14,17 ; that frequent repeated administration of high-dose inhaled glucocorticoid in patients with acute severe asthma has similar efficacy to an oral glucocorticoid 18,19 ; that in adults, quadrupling the dose of inhaled glucocorticoid during worsening asthma results in fewer severe exacerbations 20 ; and that combination beclomethasone dipropionatealbuterol used as needed has greater efficacy than as-needed albuterol alone. 21 A reduction in the median Feno from baseline to month 12 was observed with budesonide maintenance therapy (from 38 to 25 ppb) and with as-needed budesonide-formoterol (from 37 to 26 ppb), which indicates that in patients with mild asthma who have not been treated previously with a glucocorticoid, airway inflammation as measured by Feno is highly responsive to inhaled glucocorticoid therapy.…”

Inhaled Budesonide Does Not Affect Hypoxic Pulmonary Vasoconstriction at 4559 Meters of Altitude

“…In this study, ascent to high altitude decreased FVC and FEV 1 . These findings are in line with previous studies reporting a reduction in the predicted (Basu et al, 1996;Senn et al, 2006) and absolute (Pollard et al, 1996;Hashimoto et al, 1997;Mason et al, 2003) values of FVC and FEV 1 at altitudes up to 5300 m. In our study, budesonide inhalation was started 48 hours before arrival at 4559 m to ensure a long enough intake for improving lung function (Edmonds et al, 2012;Mendes et al, 2014). However, even the highest dose of budesonide did not improve pulmonary function tests.…”

Adding nebulized corticosteroids to systemic corticosteroids for acute asthma in children: A systematic review with meta‐analysis

“…In terms of lung function, only two studies (one in the ED and one in hospitalized children) reported this outcome, and in both, children on ICS + SC significantly improved the PEFR in comparison with SC. The same result was previously described in adults using PEFR, but not with FEV1 8 . Similarly, the present review shows that adding budesonide to SC does not result in more AEs or SAEs, as was described in the last Cochrane review 8 …”

“…The same result was previously described in adults using PEFR, but not with FEV1 8 . Similarly, the present review shows that adding budesonide to SC does not result in more AEs or SAEs, as was described in the last Cochrane review 8 …”

“…8 Similarly, the present review shows that adding budesonide to SC does not result in more AEs or SAEs, as was described in the last Cochrane review. 8 The most recent GINA guidelines 4 stated that a high dose of ICS within the first hours after presentation to ED reduces the need for hospitalization in patients who do not receive SC, but the addition of ICS to SC was inconclusive, and the type of ICS, doses, and duration remained unclear; moreover, the cost is an issue that remains to be resolved. Likewise, the latest Cochrane review 8 of five studies (n = 433 patients), but only two studies 20,23 in children, showed that ICS plus SC significantly reduces hospital admission compared with SC, but with high heterogenicity (OR = 0.54 [0.36-0.81], I 2 = 52%), and stated the necessity for further research "to clarify the most appropriate drug dosage and delivery device, and to define which patients are most likely to benefit from ICS therapy."…”

Controlled Trial of Budesonide–Formoterol as Needed for Mild Asthma

“…The findings of our trial are consistent with evidence regarding the treatment of moderate and severe asthma -that maintenance and reliever therapy with inhaled glucocorticoid-formoterol results in a lower risk of severe exacerbations than maintenance therapy with an inhaled glucocorticoid-LABA and as-needed SABA 14,17 ; that frequent repeated administration of high-dose inhaled glucocorticoid in patients with acute severe asthma has similar efficacy to an oral glucocorticoid 18,19 ; that in adults, quadrupling the dose of inhaled glucocorticoid during worsening asthma results in fewer severe exacerbations 20 ; and that combination beclomethasone dipropionatealbuterol used as needed has greater efficacy than as-needed albuterol alone. 21 A reduction in the median Feno from baseline to month 12 was observed with budesonide maintenance therapy (from 38 to 25 ppb) and with as-needed budesonide-formoterol (from 37 to 26 ppb), which indicates that in patients with mild asthma who have not been treated previously with a glucocorticoid, airway inflammation as measured by Feno is highly responsive to inhaled glucocorticoid therapy.…”

Inhaled Budesonide Does Not Affect Hypoxic Pulmonary Vasoconstriction at 4559 Meters of Altitude

“…In this study, ascent to high altitude decreased FVC and FEV 1 . These findings are in line with previous studies reporting a reduction in the predicted (Basu et al, 1996;Senn et al, 2006) and absolute (Pollard et al, 1996;Hashimoto et al, 1997;Mason et al, 2003) values of FVC and FEV 1 at altitudes up to 5300 m. In our study, budesonide inhalation was started 48 hours before arrival at 4559 m to ensure a long enough intake for improving lung function (Edmonds et al, 2012;Mendes et al, 2014). However, even the highest dose of budesonide did not improve pulmonary function tests.…”

Adding nebulized corticosteroids to systemic corticosteroids for acute asthma in children: A systematic review with meta‐analysis

“…In terms of lung function, only two studies (one in the ED and one in hospitalized children) reported this outcome, and in both, children on ICS + SC significantly improved the PEFR in comparison with SC. The same result was previously described in adults using PEFR, but not with FEV1 8 . Similarly, the present review shows that adding budesonide to SC does not result in more AEs or SAEs, as was described in the last Cochrane review 8 …”

“…The same result was previously described in adults using PEFR, but not with FEV1 8 . Similarly, the present review shows that adding budesonide to SC does not result in more AEs or SAEs, as was described in the last Cochrane review 8 …”

“…8 Similarly, the present review shows that adding budesonide to SC does not result in more AEs or SAEs, as was described in the last Cochrane review. 8 The most recent GINA guidelines 4 stated that a high dose of ICS within the first hours after presentation to ED reduces the need for hospitalization in patients who do not receive SC, but the addition of ICS to SC was inconclusive, and the type of ICS, doses, and duration remained unclear; moreover, the cost is an issue that remains to be resolved. Likewise, the latest Cochrane review 8 of five studies (n = 433 patients), but only two studies 20,23 in children, showed that ICS plus SC significantly reduces hospital admission compared with SC, but with high heterogenicity (OR = 0.54 [0.36-0.81], I 2 = 52%), and stated the necessity for further research "to clarify the most appropriate drug dosage and delivery device, and to define which patients are most likely to benefit from ICS therapy."…”

Controlled Trial of Budesonide–Formoterol as Needed for Mild Asthma

“…The findings of our trial are consistent with evidence regarding the treatment of moderate and severe asthma -that maintenance and reliever therapy with inhaled glucocorticoid-formoterol results in a lower risk of severe exacerbations than maintenance therapy with an inhaled glucocorticoid-LABA and as-needed SABA 14,17 ; that frequent repeated administration of high-dose inhaled glucocorticoid in patients with acute severe asthma has similar efficacy to an oral glucocorticoid 18,19 ; that in adults, quadrupling the dose of inhaled glucocorticoid during worsening asthma results in fewer severe exacerbations 20 ; and that combination beclomethasone dipropionatealbuterol used as needed has greater efficacy than as-needed albuterol alone. 21 A reduction in the median Feno from baseline to month 12 was observed with budesonide maintenance therapy (from 38 to 25 ppb) and with as-needed budesonide-formoterol (from 37 to 26 ppb), which indicates that in patients with mild asthma who have not been treated previously with a glucocorticoid, airway inflammation as measured by Feno is highly responsive to inhaled glucocorticoid therapy.…”

Inhaled Budesonide Does Not Affect Hypoxic Pulmonary Vasoconstriction at 4559 Meters of Altitude

“…In this study, ascent to high altitude decreased FVC and FEV 1 . These findings are in line with previous studies reporting a reduction in the predicted (Basu et al, 1996;Senn et al, 2006) and absolute (Pollard et al, 1996;Hashimoto et al, 1997;Mason et al, 2003) values of FVC and FEV 1 at altitudes up to 5300 m. In our study, budesonide inhalation was started 48 hours before arrival at 4559 m to ensure a long enough intake for improving lung function (Edmonds et al, 2012;Mendes et al, 2014). However, even the highest dose of budesonide did not improve pulmonary function tests.…”