Different oral corticosteroid regimens for acute asthma

Area of Science:

• Pulmonology
• Clinical Pharmacology

Background:

• Asthma exacerbations, or acute asthma attacks, affect millions globally and typically require prompt oral steroid treatment.
• Oral steroids like prednisolone and dexamethasone are effective but carry risks, with current dosing guidelines lacking international consensus.
• Optimal oral steroid dosing for asthma exacerbations aims to maximize recovery while minimizing adverse events, an area with limited evidence.

Purpose of the Study:

• To evaluate the efficacy and safety of different doses and durations of oral steroids for treating asthma exacerbations in adults and children.

Main Methods:

• A systematic review and meta-analysis of parallel randomized controlled trials (RCTs) comparing various oral steroid regimens for asthma exacerbations.
• Searches included major trial registries and reference lists, up to April 2016, including published and unpublished data.
• Data were analyzed using random-effects models, with outcomes assessed using the GRADE system.

Main Results:

• Eighteen RCTs with 2438 participants compared different doses, durations, or types (prednisolone vs. dexamethasone) of oral steroids.
• Due to infrequent events and heterogeneity in outcome reporting, no convincing evidence emerged for differences in efficacy or safety between varied regimens.
• Most outcomes were assessed as low or very low quality due to imprecision and risk of bias, limiting confidence in the findings.

Conclusions:

• Current evidence is insufficient to determine if shorter or lower-dose oral steroid regimens are less effective or if higher doses/longer courses cause more adverse events.
• Larger, well-designed trials are necessary to establish optimal oral steroid dosing for asthma exacerbations.
• Factors like palatability and adherence may influence clinical decisions for individual patients.