Acute severe asthma treated without steroids

Luksza, A R

doi:10.1016/0007-0971(82)90003-1

Cited by 54 publications

(12 citation statements)

References 6 publications

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“…4 Corticosteroids also have been reported not to affect the clinical outcome in adults with severe asthma admitted to an intensive care unit. 5 Two studies have specifically questioned the efficacy of corticosteroids for preschool-aged children with viral respiratory infection-induced asthma. 6,7 However, treatment of preschool-aged children with a high dose of systemic corticosteroid, 4 mg/kg methylprednisolone (4 mg/kg methylprednisolone would be equivalent to 5 mg/kg prednisolone based on standard equivalency tables), in the emergency department substantially decreased a 3-hour decision for hospital admission.…”

Section: To the Editormentioning

confidence: 99%

“…3,4 In fact, the diagnosis of asthma is more uncertain in young children, because it is a heterogeneous condition with different underlying pathophysiological pathways. 5 This age group exhibits episodic disease and experiences disproportionately greater morbidity and healthcare use, compared with school-aged children, but have minimal symptoms consistent with persistent asthma between these episodes. 3,6 However, no guidelines provide different recommendations whether to administer beta mimetics or corticosteroids based on age, and the recommendations for emergency department (ED) management are not different for preschoolaged children compared with school-aged children.…”

Section: Professor Emeritus University Of Iowa Iowa City Iowamentioning

confidence: 99%

“…3,6 However, no guidelines provide different recommendations whether to administer beta mimetics or corticosteroids based on age, and the recommendations for emergency department (ED) management are not different for preschoolaged children compared with school-aged children. A recent meta-analysis 5 has evaluated the efficacy of oral corticosteroids compared with placebo in preschool-aged children with asthma and concluded that this treatment was associated with a lower hospitalization rate and may be beneficial in the ED and hospital setting. In addition, a clinical trial presented at the annual Pediatric Academic Societies meeting (2017) by Dalziel et al, not yet published, compared a 3-day course of…”

Section: Professor Emeritus University Of Iowa Iowa City Iowamentioning

confidence: 99%

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Randomized trial of dexamethasone versus prednisone for children with acute asthma exacerbations: why?

Weinberger

2018

The Journal of Pediatrics

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interval, which one is inclined to use given the other shortcomings of the study (relatively small sample size with recurrences, not all participants were still blinded at the time of the questionnaire, the diagnosis of AOM was not verified, and the questionnaire response rates were less than ideal), the findings do not seem clinically significant (ie, recurrences 1.1 times more common in the children who had received antibiotics). In summary, we feel that modeling a higher rate of recurrences in children receiving antibiotics, as the letter suggests, would be contrary to the bulk of the available evidence on the topic.

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Section: To the Editormentioning

confidence: 99%

Section: Professor Emeritus University Of Iowa Iowa City Iowamentioning

confidence: 99%

Section: Professor Emeritus University Of Iowa Iowa City Iowamentioning

confidence: 99%

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Randomized trial of dexamethasone versus prednisone for children with acute asthma exacerbations: why?

Weinberger

2018

The Journal of Pediatrics

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“…The first trial was conducted by the al1. [95][96][97][98][99] Medical Research Council in 1956, which showed beneficial effects (improving the clinical scores) of cortisone acetate when given for 24 h in terms of improving clinical scores.84 Subsequent studies in adults show a significantly greater improvement in FEVl after intravenous hydrocortisone 2 mglkg followed by 0.5 mg/kg per h treated for 24 hX5 and fewer number of patients needing hospital admission when treated with intravenous methylprednisol-one86.87 compared to placebo. Studies in children have also shown benefits of steroids in term of improvement in peak expiratory flow (PEF) after single dose predni~olone~~ or 6 hourly prednisolone 2 mg/ kgX9 Table 3 Pharmacokinetics of steroids Treating children with acute asthma with high dose prednisolone 40-80mg a day for 1 week has been shown to reduce the need for further intervention with various anti-asthma drugs.…”

Section: Acute Severe Asthmamentioning

confidence: 99%

Steroid therapy in obstructive airway diseases

Zainudin

1997

Respirology

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Asthma and chronic obstructive pulmonary disease (COPD) are two common illnesses that cause significant morbidity and mortality. Steroids are widely used in both conditions. They act through steroid or glucocorticoid receptors (GR) causing up or down regulation of protein synthesis resulting in an increase in lipocortin 1 and beta 2 adrenergic receptors, and decreased levels and activities of cytokines or cytokine receptors, which reduces the inflammatory process in the airways and decreases bronchial hyperreactivity. Consequently symptoms of airway obstruction are alleviated and lung function is improved. In asthma, steroids have been convincingly shown to be effective in the treatment of both acute exacerbations and chronic condition. In COPD, however, only a subset of patients seem to respond favourably to steroid therapy. Therapeutic trials are therefore recommended before committing to a long-term treatment in order to determine this subset of patients, as no markers of steroid responsiveness can be identified. The inhaled steroids currently available have a good safety profile with significant side effects occurring only occasionally. Such side effects are usually confined to the oropharynx, causing local irritation, candidiasis and dysphonia, which can be easily overcome. Biochemical abnormalities involving bone, adrenal, carbohydrate and lipid profiles have been noted with high doses of inhaled steroids; however, these have no significant clinical effects.

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“…Since this term is not strictly defined, it is not surprising that controversy exists regarding the efficacy of corticosteroids in status asthmaticus. [46][47][48] Recently, increasing objective evidence has been presented that support a role for cortico-395 steroids in the management of acute severe asthma attacks. [49][50][51][52] Corticosteroids are thought to be very helpful in lessening the potential occurrence of sudden death in status asthma.…”

Section: Status Asthmaticusmentioning

confidence: 99%