Second-line treatment option for children aged 18 years and under with an acute severe asthma exacerbation: a systematic review and meta-analysis of randomised controlled trials.
Archives of Disease in Childhood · 2025-06-26 · Meta-analysis
Abstract
IMPORTANCE: Evidence regarding second-line treatment for severe asthma is limited. OBJECTIVES: To evaluate the safety and efficacy of intravenous aminophylline, intravenous short-acting beta agonist (SABA), intravenous magnesium sulphate, intravenous ketamine or subcutaneous adrenaline as a second-line treatment for severe asthma. METHODS: We included only randomised controlled trials (RCTs) and followed the international guidelines for conducting systematic reviews. We performed a comprehensive literature search up to May 2024. Outcomes included morbidity, escalation of care, length of hospital stay, adverse events, mortality and changes in lung functions. RESULTS: Nine RCTs were included (total participants=546). Compared with other treatments, intravenous aminophylline showed no significant difference in the duration of hospital stay in hours, except for critically ill ventilated patients who had a shorter stay (mean difference (MD)=-12.99, 95% CI -33.13 to 7.15). The need for additional intravenous medications (RR=2.17, 95% CI 0.48 to 9.71) and asthma severity scores postinterventions (MD=0.97, 95% CI -0.91 to 2.85) was similar. More nausea and emesis were observed in the intravenous aminophylline group. The intravenous SABA group showed no difference in hospital stay (MD=-10.12, 95% CI -45.74 to 25.49) or need for ventilation (RR=0.25, 95% CI 0.03 to 2.21). There were no frequent serious adverse events. The intravenous magnesium sulphate group had a lower hospitalisation rate (RR=1.52, 95% CI 1.26 to 1.84), reduced need for additional intravenous medication (RR=6.30, 95% CI 2.62 to 15.17) and a rapid improvement in asthma severity scores (p<0.05). CONCLUSION: There is low-to-very-low certainty evidence demonstrating the superiority of any intravenous second-line treatment options for acute asthma. PROSPERO REGISTRATION NUMBER: CRD42023405226.
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Tags
Adrenaline · Anaesthetics · Cardiovascular drugs · Children · Ketamine · Magnesium · Mortality & survival · Other drugs · Respiratory drugs
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