Steroid therapy in acute asthma

The objective of this study was to determine the effect of steroid therapy on pulmonary function, admission rates, and relapse rates in patients presenting with acute exacerbations of asthma. Computerized MEDLINE and SCIENCE CITATION searches were combined with review of reference lists from book chapters and articles to identify published randomized trials on steroid interventions. Over 700 articles were reviewed by two independent reviewers who identified 30 relevant randomized controlled trials for analysis. Study validity was independently assessed by two reviewers and information regarding populations, interventions, and outcomes was abstracted. Binary outcomes were combined and reported as odds ratios (OR), using the Mantel-Haenszel method. Individual and pooled effect sizes (ES) were determined for pulmonary function data. The authors found that the use of steroids early in the treatment of asthmatic exacerbations reduces admissions in adults (common OR ; 95% confidence interval (CI) , ) and children (OR –). They found steroids effective in preventing relapse in the outpatient treatment of asthmatic exacerbations (OR ; CI , ). Oral and intravenous steroids appear to have equivalent effects on pulmonary function in acute exacerbations (ES −; CI −, ). The authors conclude that overall, steroid therapy provides important benefits to patients presenting to emergency departments with acute exacerbations of asthma. Further research into dosage, alternative routes of administration, and alternative outcome measures is needed.

High-dose corticosteroids in a parenteral pulse form were first used in renal transplant patients to prevent graft rejection. (2) Since then, pulsed high-dose corticosteroids have been used successfully for many systemic and cutaneous disorders. (3-13) A novel approach to minimize the side effects of corticosteroids has been suggested to give corticosteroids in a weekly pulse form (giving 5 mg betamethasone in a single morning dose after breakfast on 2 consecutive days every week) till the arrest (stoppage of progression) of the disease as well as amelioration of the signs and symptoms. (14) The weekly dose of the oral corticosteroids is reduced by mg every 2 to 4 weeks depending upon the severity of the condition. This form of weekly pulse therapy with CS has been called oral mini-pulse therapy (OMP) (14) to differentiate it from the parenteral corticosteroid pulse therapy successfully used for many autoimmune systemic as well as cutaneous diseases for more than 30 years now. (3-13) OMP has been successfully used in many steroid responsive dermatoses such as vitiligo, (14-15) alopecia areata, (16-18) myositis, (19) and even infantile hemangioma. (20) Most of these studies report a rapid arrest of progression of the condition and a low incidence of corticosteroid-related minor side effects in these patients. No acute or clinical side effects were noted in our patient. Hematological and clinical chemistry followed at monthly intervals did not reveal any abnormality in this patient. There was no weight gain or any other clinical side effect noted in this patient. OMP with corticosteroids has many advantages over daily or alternate day steroids such as less frequent dosing thus ensuring compliance and decreased risk of short- and long-term side effects associated with corticosteroid therapy. Controlled studies with corticosteroid OMP in a larger number of patients having LP and other steroid responsive dermatoses are required.

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18 trials (1179 participants) were included in this updated review . The injection sites varied from epidural sites and facet joints (. intra-articular injections, peri-articular injections and nerve blocks) to local sites (. tender- and trigger points). The drugs that were studied consisted of corticosteroids, local anesthetics and a variety of other drugs. The methodological quality of the trials was limited with 10 out of 18 trials rated as having a high methodological quality. Statistical pooling was not possible due to clinical heterogeneity in the trials. Overall, the results indicated that there is no strong evidence for or against the use of any type of injection therapy .

Steroid therapy in acute asthma

steroid therapy in acute asthma

18 trials (1179 participants) were included in this updated review . The injection sites varied from epidural sites and facet joints (. intra-articular injections, peri-articular injections and nerve blocks) to local sites (. tender- and trigger points). The drugs that were studied consisted of corticosteroids, local anesthetics and a variety of other drugs. The methodological quality of the trials was limited with 10 out of 18 trials rated as having a high methodological quality. Statistical pooling was not possible due to clinical heterogeneity in the trials. Overall, the results indicated that there is no strong evidence for or against the use of any type of injection therapy .

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