Systemic Steroids Given During an Asthma Attack
Benefits in NNT
1 in 8 were helped (preventing hospital admission)
1 in 10 were helped (preventing asthma relapse)
1 in 11 were helped (preventing a later hospital admission)
75-80% saw no benefit
12.5% were helped by preventing hospital admission
10.0% were helped by preventing asthma relapse
9.1% were helped by preventing a later hospital admission
Harms in NNT
None were harmed (serious side effects)
0% were harmed by serious side effects
SourceRowe BH et al. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev. 2001;(1):CD002178.
Efficacy EndpointsHospital admission, asthma relapse, subsequent hospitalization for asthma
Harm EndpointsSteroid adverse drug effects
NarrativeAdmissions: In the included 12 studies (N = 863), steroids were always given within an hour. The impact seen in these trials might be surprising to many given the conventional wisdom that effects of steroids are delayed. The effects were consistent across the pediatric and adult populations. Of note, all steroids were administered intravenously or intramuscularly in the adults but given orally in pediatrics.
Relapse Rates/Subsequent Hospitalizations: There were 6 studies (N = 374), both pediatric and adults. Steroids were administered intramuscularly in one, but given orally in the remaining five, for a duration of 3-10 days. The baseline relapse rates for asthmatics has been noted to be 12-16% at 2 weeks. In this review, most studies followed patients up for a maximum of 7-10 days; however, one extended the period to 21 days.
CaveatsAdmissions: The average admission rate for asthmatics is 10-20%; however, in the included studies, the admission rate was generally greater than 40%, indicating a relatively sick asthmatic population. In addition, the authors noted significant heterogeneity between the studies and performed a pre-planned subgroup analysis to assess the impact of steroids based on severity of disease. As expected, the impact of steroids was larger (NNT = 5) in the more severe asthmatic populations. For harm, the only aggregated data we were able to find appears to suggest that there may be a small, clinically difficult-to-detect negative impact of systemic steroids on growth in children due to intermittent steroids in asthma, while there was no detectable impact of inhaled corticosteroids. These effects were from small, heterogeneous studies and should be considered preliminary.1
Relapse Rates/Subsequent Hospitalizations: The actual steroid, dosage and duration of course varied between studies so judgment still informs these areas of management. For harm, the only aggregated data we were able to find appears to suggest that there may be a small, clinically difficult-to-detect negative impact of systemic steroids on growth in children due to intermittent steroids in asthma, while there was no detectable impact of inhaled corticosteroids. These effects were from small, heterogeneous studies and should be considered preliminary.1