Prescribe systemic corticosteroids in acute asthma

doi:10.1136/bmj.b1234

Published 3 April 2009, doi:10.1136/bmj.b1234
Cite this as: BMJ 2009;338:b1234

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Prescribe systemic corticosteroids in acute asthma

Steven Doherty, associate professor, director , emergency consultant¹^,2

¹ Rural Clinical School, University of Newcastle, Australia , ² Locked Bag 9783, NEMSC, Tamworth, NSW 2348, Australia

Correspondence to: Steven.doherty@hnehealth.nsw.gov.au

Systemic corticosteroids reduce admission rates, relapse rates,and symptom duration and should be used for most acute exacerbationsof acute asthma

The first 150 words of the full text of this article appear below.

Globally, 300 million people are estimated to have asthma, andthe prevalence in most countries is increasing.¹ Systematicreviews have found that systemic corticosteroids in acute asthmareduce admission rates, symptom duration, β agonist use,and repeat presentations for medical care.² ³ ⁴ ⁵ However, evidenceexists that corticosteroids are underprescribed in acute asthma,with prescribing rates ranging from <60% for mild asthmato <85% for moderate and severe asthma across multiple sites.⁶Systemic corticosteroids are recommended and should be prescribed,unless there are other contraindications, for all but the mildestof acute exacerbations of asthma.¹

Meta-analyses have reviewed the role of corticosteroids in acuteasthma.² ³ ⁴ ⁵ A meta-analysis of seven randomised controlledtrials (426 admitted children aged 1-18 years) found that thosewho received systemic corticosteroids were discharged earlier(number needed to treat (NNT) 3) and were less likely to relapsewithin one to three months (odds ratio 0.19; 95% confidenceinterval 0.07 . . . [Full text of this article]

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