Adding nebulized corticosteroids to systemic corticosteroids for acute asthma in children: A systematic review with meta-analysis.
Pediatric Pulmonology · 2020-07-14 · Meta-analysis
Abstract
UNLABELLED: International guidelines have recommended the use of inhaled beta-2 agonists and systemic corticosteroids (SCs) as the first-line treatment for acute asthma. OBJECTIVE: To evaluate the evidence for the efficacy of inhaled corticosteroids (ICSs) in addition to SCs compared to SCs alone in children with acute asthma in the emergency department (ED) or during hospitalization. DATA SOURCES: Five electronic databases were searched. STUDY SELECTION: All randomized clinical trials that compared ICS (via nebulizer or metered dose inhaler) plus SC (oral or parenteral) with placebo (or standard care) plus SC were included without language restriction. DATA EXTRACTION: Two reviewers independently reviewed all the studies. The primary outcomes were hospital admission and hospital length of stay (LOS), and secondary outcomes were readmissions during follow-up, ED-LOS, lung function, asthma clinical score, oxygen saturation, and heart and respiratory rates. RESULTS: Nine studies (n = 1473) met the inclusion criteria. In all the studies, the ICS was budesonide. Compared to SC alone, adding budesonide to SC did not affect hospitalization rate, but decreased hospital LOS by more than 1 day (MD = -29.08 hours [-39.9 to -18.3]; I2 = 0%, P = < .00001). Moreover, adding budesonide significantly improved the acute asthma severity score among patients at ED. CONCLUSIONS: Compared to SC alone, adding budesonide to SC does not affect the hospitalization rate, but decreases the LOS and improves the acute asthma score in children in an ED setting.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Children · Inhaled corticosteroids · Respiratory drugs
Related articles
- Effect of budesonide on hospitalization rates among children with acute asthma attending paediatric emergency department: a systematic review and meta-analysis. (World J Pediatr, 2021)
- Nebulized Inhaled Corticosteroids in Asthma Treatment in Children 5 Years or Younger: A Systematic Review and Global Expert Analysis. (J Allergy Clin Immunol Pract, 2020)
- Role of Inhaled Corticosteroids for Asthma Exacerbation in Children: An Updated Meta-Analysis. (J Emerg Trauma Shock, 2020)
- Safety of corticosteroids in young children with acute respiratory conditions: a systematic review and meta-analysis. (BMJ Open, 2019)
- Effectiveness of inhaled corticosteroids in the treatment of acute asthma in children in the emergency department: a meta-analysis. (Ann Med, 2014)
- Inhaled versus systemic corticosteroids for acute asthma in children. A systematic review. (Pediatr Pulmonol, 2014)