The effectiveness of glucocorticoids in treating croup: meta-analysis

Ausejo, Monica; Saenz, Antonio; Pham, Ba’; Kellner, James D.; Johnson, David W.; Moher, David; Klassen, Terry P

doi:10.1136/bmj.319.7210.595

Cited by 124 publications

(69 citation statements)

References 27 publications

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“…43 Such patients may benefit from a short course of therapy with corticosteroids, as shown in several studies of children with RSV tracheobronchitis [44][45][46] and croup. [47][48][49][50][51] Steroid therapy is also supported by the linear dose-response relationship between concentration of steroids and reduction in pathology score in RSV pneumonia in cotton rats. 52 Methylprednisolone (1 mg/kg/d) was given to some of our RSV-positive patients with tracheobronchitis with rapid symptomatic relief (anecdotal experience).…”

Section: Org Frommentioning

confidence: 98%

The natural history of respiratory syncytial virus infection in cancer and transplant patients: implications for management

Anaissie

Mahfouz

Aslan

et al. 2004

Blood

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Respiratory syncytial virus (RSV) has been reported to cause severe morbidity and mortality among cancer patients receiving chemotherapy with or without autologous peripheral blood stem cell transplantation (APBSCT). However, little is known about the natural history of this infection in these patients, and current standard practice, aerosolized ribavirin plus intravenous immunoglobulin (IVIG), is extremely expensive, difficult to use, and not supported by controlled clinical trials. The purpose of this observational study was to determine the frequency, seasonality, morbidity, and mortality of RSV infection in a group of cancer pa- IntroductionRespiratory syncytial virus (RSV) is thought to cause rare but severe community and nosocomial respiratory infections in immunocompromised adults, including cancer patients, [1][2][3][4][5][6][7][8][9] and to occur almost exclusively during winter. [10][11][12][13] Recommendations for the management of RSV infections in cancer patients include strict infection control measures, delay in the therapy for the underlying disease, and treatment with aerosolized ribavirin plus high-dose intravenous immunoglobulin (IVIG). [3][4][5][6][7][8][9]14 These strategies are associated with huge costs, toxicity, disruption of patient care activities, and delay in treating the underlying cancer. 15,16 Furthermore, these recommendations were based on studies that did not evaluate a homogenous patient population and, most important, failed to include a control group whose respiratory cultures were negative for RSV. We have previously reported on 10 myeloma patients with positive respiratory tract cultures for RSV who successfully underwent autologous peripheral blood stem cell transplantation (APBSCT) without receiving RSV-specific therapy. 17 In this prospective observational study, we sought to determine the incidence and seasonality of RSV infection in a homogenous group of cancer patients not receiving RSV-specific therapy. We also determined the type of and risk for complications associated with RSV by including a control group whose respiratory cultures were negative for this virus. Patients, materials, and methodsCancer patients receiving cytotoxic chemotherapy, with or without APBSCT or allogeneic bone marrow transplantation (allo-BMT), were evaluated at the University of Arkansas for Medical Sciences in Little Rock. A written informed consent for specimen collection was obtained in keeping with institutional policies. This evaluation occurred over a period of 12 months (October 3, 1997, to October 14, 1998. Nasopharyngeal washings were collected into a sterile cup and transported on wet ice to the virology laboratory, generally within 2 hours. Bronchoalveolar lavage specimens and tissue obtained by open lung biopsy and autopsy were also collected for culture when available, with tissue specimens homogenized prior to culture inoculation. Specimens were inoculated into tubes containing human diploid embryonic lung (MRC-5) fibroblast cells and checked daily during the first week and ...

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Section: Org Frommentioning

confidence: 98%

The natural history of respiratory syncytial virus infection in cancer and transplant patients: implications for management

Anaissie

Mahfouz

Aslan

et al. 2004

Blood

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“…Meta-analyses of RCTs [199][200][201] have consistently demonstrated significant improvements in patients treated with corticosteroids compared with controls. Corticosteroids decrease the time spent in the emergency room or hospital, the number of return visits and hospital admissions.…”

Section: Corticosteroidsmentioning

confidence: 99%

“…Corticosteroids decrease the time spent in the emergency room or hospital, the number of return visits and hospital admissions. They also reduce the use of epinephrine, the need for intubation and the risk of reintubation [199][200][201][202].…”

Section: Corticosteroidsmentioning

confidence: 99%

Medicines used in respiratory diseases only seen in children

Lenney¹,

Al²,

Bont³

et al. 2009

European Respiratory Journal

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Detailed literature searches were carried out in seven respiratory disease areas. Therapeutic evidence for efficacy of medicinal products was assessed using the Grades of Recommendation, Assessment and Evaluation (GRADE) methodology, as well as an assessment of safety and side-effects.Systemic corticosteroids may reduce the development of bronchopulmonary dysplasia but have serious side-effects. Antioxidants need further study to demonstrate whether they have long-term benefits. Treatments for acute bronchiolitis have shown little benefit but new antiviral and monoclonal antibodies need further assessment. Well-constructed studies are needed to confirm the value of inhaled corticosteroids and/or montelukast in the management of viralinduced wheeze. Corticosteroids are the treatment of choice in croup. Minimal or no information is available for the treatment of congenital lung abnormalities, bronchiolitis obliterans and interstitial lung disease.

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“…2 The findings regarding the use of corticosteroids for croup from RCTs have been confirmed and strengthened by a meta-analysis conducted by PERC members. [6][7][8] The combination of RCTs and systematic reviews in this area nicely completes the clinical research loop and provides solid evidence for managing children with croup. Despite the evidence, data showed that many children with croup were not receiving optimal therapy and that there was substantial variation in hospitalization rates.…”

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confidence: 99%

“…20 The quality of the research is reflected in substantial funding from major provincial and national funders, as well as publications in high-impact journals such as the New England Journal of Medicine, 2,4 the Journal of the American Medical Association, 5,21 and the British Medical Journal. 7 The research conducted by PERC members has been principally driven by single investigators or centers and funded on a per-project basis from various sources.…”

mentioning

confidence: 99%

Bridging the Gap between Clinical Research and Knowledge Translation in Pediatric Emergency Medicine

Hartling

Scott

Johnson

et al. 2007

Academic Emergency Medicine

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In 2006, a multidisciplinary group of researchers from across Canada submitted a successful application to the Canadian Institutes for Health Research for a Canadian Institutes for Health Research Team in Pediatric Emergency Medicine. The conceptual foundation for the proposal was to bring together two areas deemed critical for optimizing health outcomes: clinical research and knowledge translation (KT). The framework for the proposed work is an iterative figure-eight model that provides logical steps for research and a seamless flow between the development and evaluation of therapeutic interventions (clinical research) and the implementation and uptake of those interventions that prove to be effective (KT). Under the team grant, we will conduct seven distinct projects relating to the two most common medical problems affecting children in the emergency department: respiratory illness and injury. The projects span the research continuum, with some projects targeting problems for which there is little evidence, while other projects involve problems with a strong evidence base but require further work in the KT realm. In this article, we describe the history of the research team, the research framework, the individual research projects, and the structure of the team, including coordination and administration. We also highlight some of the many advantages of bringing this research program together under the umbrella of a team grant, including opportunities for cross-fertilization of ideas, collaboration among multiple disciplines and centers, training of students and junior researchers, and advancing a methodological research agenda.ACADEMIC EMERGENCY MEDICINE 2007; 14:968-977 ª

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The effectiveness of glucocorticoids in treating croup: meta-analysis

Cited by 124 publications

References 27 publications

The natural history of respiratory syncytial virus infection in cancer and transplant patients: implications for management

The natural history of respiratory syncytial virus infection in cancer and transplant patients: implications for management

Medicines used in respiratory diseases only seen in children

Bridging the Gap between Clinical Research and Knowledge Translation in Pediatric Emergency Medicine

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