Chest
Clinical InvestigationsAsthmaCorticosteroids in the Emergency Department Therapy of Acute Adult Asthma: An Evidence-Based Evaluation
Section snippets
Search Strategy
To identify all relevant studies, a computerized MEDLINE search was conducted. We searched for studies published in the English language for the years 1966 to October 1998. The following MeSH terms were used in the search: (1) Asthma OR Wheez*, AND (2) Glucocorticoids OR Steroids, AND3 Acute* OR Emerg. The apply limits were: (1) language, English; (2) target population, adults> 18 years old; and (3) publications type, clinical trials. Other sources of relevant articles were the CURRENT CONTENTS
Computerized Search
A total of 87 articles were identified in the initial search. Of these, 21 RCTs were selected for inclusion.2456828293031323334353637383940414243The κ-agreement was 0.81 for this assessment (very good agreement). Reasons for exclusion were the following: non-RCT (40/67, 60%); outpatient studies (12/67, 18%); nonoriginal data (12/67, 18%); and study involved children (3/67, 4%). Following validity assessment, two studies were excluded because they did not fit any of the categories for analysis.
Discussion
The purpose of this review was to perform an evidence-based evaluation of the effectiveness of CCS administration in the treatment of adult patients with acute exacerbations of asthma. This study met most of the methodological criteria that have been suggested as guidelines for scientific reviews,44 and all included trials were randomized and placebo controlled. In addition, this review has identified five trials published between 1994 and 1998, totaling 434 new subjects, that were not included
Conclusion
With reference to the early administration of CCSs in the ED treatment of adult patients with acute asthma, this evidence-based evaluation suggests the following: (1) parenteral administration probably requires > 6 to 24 h to improve pulmonary function in the patient (on the contrary, high doses of inhaled CCSs [one study]8 increase pulmonary function 1 to 3 h after therapy); (2) comprehensible conclusions about admission rates in the ED setting are difficult to make (overall, there is evidence
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