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Prescribe systemic corticosteroids in acute asthma

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

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  1. Steven Doherty, associate professor, director 1, emergency consultant2
  1. 1Rural Clinical School, University of Newcastle, Australia
  2. 2Locked Bag 9783, NEMSC, Tamworth, NSW 2348, Australia
  1. Correspondence to: Steven.doherty{at}hnehealth.nsw.gov.au
  • Accepted 9 October 2008

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

The clinical problem

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

The evidence for change

Meta-analyses have reviewed the role of corticosteroids in acute asthma.2 3 4 5 A meta-analysis of seven randomised controlled trials (426 admitted children aged 1-18 years) found that those who received systemic corticosteroids were discharged earlier (number needed to treat (NNT) 3) and were less likely to relapse within one to three months (odds ratio 0.19; 95% confidence interval 0.07 to 0.55, NNT=3).3 A meta-analysis of six randomised controlled trials (374 discharged adults and children) showed …

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