High-dose corticosteroids in severe acute asthma.

Britton, Mark; Collins, J. V.; Brown, D J; Fairhurst, N P; Lambert, R G

doi:10.1136/bmj.2.6027.73

Cited by 67 publications

(13 citation statements)

References 3 publications

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“…A subgroup of 11 patients was followed to recovery on a standardised treatment regimen of bronchodilators and corticosteroids (Britton et al, 1976). Clinical improvement was assessed by spirometry.…”

Section: Resultsmentioning

confidence: 99%

“…We were unable therefore to in- Table 1 Grading the severity of acute asthma After Rees (1968) After Jones (1971) Grade III Totally confined to a chair or bed IV Moribund fluence treatment except in a subgroup of 11 patients, who formed part of a clinical trial of steroid treatment and were followed until recovery on a standardised regimen of bronchodilators (Britton et al, 1976). In this group the speed of onset could be related to the duration of recovery, as the different steroid regimens made little difference to the speed of recovery themselves.…”

Section: Methodsmentioning

confidence: 99%

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"Acute" asthma in adults.

Bellamy¹,

Collins²

1979

Thorax

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Forty-four adult patients with acute severe asthma were studied on admission to a general hospital to determine the mode of presentation and clinical severity of the acute illness. Most patients described poorly controlled wheezing for a mean period of five weeks before a more rapid deterioration, usually over 24 hours, caused them to seek medical attention. The clinical severity of the acute attack was not related to the duration of acute wheezing before admission to hospital. Recovery, studied in 11 of the patients, was slow, and most had reached only 70% of their predicted spirometric values after seven days' treatment in hospital. The rate of recovery was not influenced by the antecedent history of acute wheezing. Very sudden deterioration from a background of good control appears to be uncommon in adults with asthma who present to hospital as emergencies, and it is likely that improvement in the standard of routine management of asthmatics at home would prevent many such admissions.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

"Acute" asthma in adults.

Bellamy¹,

Collins²

1979

Thorax

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“…Studies comparing moderate and high doses of corticosteroids have repeatedly failed to find evidence of a dose response relationship in alleviating acute asthma. [26][27][28][29][30][31][32][33][34][35] Only two studies have looked at doses similar to those recommended by the BTS. Engel and colleagues 35 found no difference between prednisolone 50 mg and methylprednisolone 1 g while Webb 36 reported a significant dose response relationship between prednisolone 0.2, 0.4 and 0.6 mg/kg, with the lower doses being significantly less effective than 0.6 mg/kg daily.…”

Section: Discussionmentioning

confidence: 99%

Randomised pragmatic comparison of UK and US treatment of acute asthma presenting to hospital

Innes

Stocking²,

Daynes³

et al. 2002

Thorax

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Background: Systemic corticosteroids and inhaled β 2 agonists are accepted first line treatments for acute severe asthma, but there is no consensus on their optimum dosage and frequency of administration. American regimens include higher initial dosages of β 2 agonists and corticosteroids than UK regimens. Methods: In a prospective, pragmatic, randomised, parallel group study, 170 patients of mean (SD) age 37 (12) years with acute asthma (peak expiratory flow (PEF) 212 (80) l/min) presenting to hospital received treatment with either high dose prednisolone and continuous nebulised salbutamol as recommended in the US or lower dose prednisolone and bolus nebulised salbutamol as recommended in the UK by the BTS. Results: Outcome measures were: ∆PEF at 1 hour (BTS 89 l/min, US 106 l/min, p=0.2, CI -8 to 41) and at 2 hours (BTS 49 l/min, US 101 l/min, p<0.0001, CI 28 to 77); time to discharge if admitted (BTS 4 days, US 4 days); rates of achieving discharge PEF (>60%) at 2 hours (BTS 64%, US 78%, p=0.04); time to regain control of asthma as measured by PEF >80% best with <20% variability (BTS 3 days, US 4 days, p=0.6); PEF at 24 hours in patients admitted (BTS 293 l/min, US 288 l/min, p=0.8); and control of asthma in the subsequent month (no significant differences). Conclusions: Treatment with higher doses of continuous nebulised salbutamol leads to a greater immediate improvement in PEF but the degree of recovery at 24 hours and speed of recovery thereafter is achieved as effectively with lower corticosteroid doses as recommended in the British guidelines.

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“…They noted no difference in FEV 1 or peak flow recovery rates over the study period. 15 Raimondi, in a study comparing high (80 mg/kg per day) versus low (6 mg/kg per day) doses of hydrocortisone in patients in status asthmaticus, determined there was no significant difference in spirometric measurements after 5 days of treatment. 16 In 1990, Engel determined that 1000 mg intravenous methylprednisolone per day conferred no superiority to 50 mg oral prednisolone per day in the treatment of severe, acute asthma attacks when looking at FEV 1 after 12 weeks.…”

Section: Dose-responsementioning

confidence: 96%

Systemic Steroids for the Treatment of Acute Asthma

Sherman¹,

Verceles²,

Lang³

2006

Clinical Pulmonary Medicine

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Despite over 50 years of clinical experience, many uncertainties persist with respect to the onset of action, doseresponse characteristics, duration of treatment, and optimal route of administration of systemic steroids when used in the treatment of severe acute asthma. Studies show that treating severe acute asthma with systemic corticosteroids within 1 hour of presentation to the emergency department lowers hospitalization rates and improves pulmonary function. The onset of action may be seen in as little as 2 hours in studies using peak flow, but may be delayed as much as 6 hours in studies using forced expiratory volume in 1 second as the pulmonary function outcome measure. A clear dose-response is seen at doses below 40 mg per day of methylprednisolone or equivalent; however, there is limited evidence for any added efficacy when doses above 60 to 80 mg per day are administered. There is no clear benefit of intravenous systemic steroids over oral steroids for treatment of severe acute asthma. High-dose inhaled corticosteroids may have a potential role, but further studies are needed to confirm efficacy. There is good evidence that a short course of oral systemic steroids for 3 to 7 days after initial steroid therapy prevents rebound asthma symptoms; no steroid taper is required if the patient was receiving inhaled steroids. Intramuscular steroids are at least equally effective and may be useful in patients who poorly adhere to their medication regimens; however, they are associated with more side effects than oral therapy.

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High-dose corticosteroids in severe acute asthma.

Cited by 67 publications

References 3 publications

"Acute" asthma in adults.

"Acute" asthma in adults.

Randomised pragmatic comparison of UK and US treatment of acute asthma presenting to hospital

Systemic Steroids for the Treatment of Acute Asthma

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