Corticosteroids for acute severe asthma

Dosing should be individualized based on disease and patient response:

Initial dose: 5 to 60 mg orally per day; may be give once a day or in divided doses
Maintenance dose: Adjust or maintain initial dose until a satisfactory response is obtained; then, gradually in small decrements at appropriate intervals decrease to the lowest dose that maintains an adequate clinical response

Comments:
-Exogenous corticosteroids suppress adrenocorticoid activity the least when given at the time of maximal activity; consider time of maximal adrenal cortex activity (2 AM to 8 AM) when dosing.
-Alternate day therapy may be considered in patients requiring long-term treatment; it may be necessary to return to a full suppressive daily dose in the event of acute flare-ups.

Uses: As an anti-inflammatory or immunosuppressive agent when corticosteroid therapy is appropriate, such as treatment of certain allergic states; nervous system, neoplastic, or renal conditions; endocrine, rheumatologic, or hematologic disorders; collagen, dermatologic, ophthalmic, respiratory, or gastrointestinal diseases; specific infectious diseases or conditions related to organ transplantation.

We included 25 studies involving 4121 participants (2511 children and 1517 adults; 93 mixed population). Four studies were of high quality with no risk of bias, 14 of medium quality and seven of low quality, indicating a moderate risk of bias for the total analysis. Nine studies were performed in low-income countries and 16 in high-income were associated with a non-significant reduction in mortality (% versus %; risk ratio (RR) , 95% confidence interval (CI) to , P value = ). A similar non-significant reduction in mortality was observed in adults receiving corticosteroids (RR , 95% CI to , P value = ). Corticosteroids were associated with lower rates of severe hearing loss (RR , 95% CI to ), any hearing loss (RR , 95% CI to ) and neurological sequelae (RR , 95% CI to ).Subgroup analyses for causative organisms showed that corticosteroids reduced mortality in Streptococcus pneumoniae (S. pneumoniae) meningitis (RR , 95% CI to ), but not in Haemophilus influenzae (H. influenzae) orNeisseria meningitidis (N. meningitidis) meningitis. Corticosteroids reduced severe hearing loss in children with H. influenzae meningitis (RR , 95% CI to ) but not in children with meningitis due to non-Haemophilus high-income countries, corticosteroids reduced severe hearing loss (RR , 95% CI to ), any hearing loss (RR , 95% CI to ) and short-term neurological sequelae (RR , 95% CI to ). There was no beneficial effect of corticosteroid therapy in low-income analysis for study quality showed no effect of corticosteroids on severe hearing loss in high-quality treatment was associated with an increase in recurrent fever (RR , 95% CI to ), but not with other adverse events.

  • Prevent asthma symptoms from occurring
  • Can reduce and/or prevent:
    • Inflammation and scarring in the airways
    • Tightening of the muscle bands around the airways (bronchospasm)
  • Do not show immediate results, but work slowly over time
  • Should be taken daily, even when you are not having symptoms
  • Should NOT be used to relieve immediate asthma symptoms.

Back to top A Note about Long-Term Controller Medicines in Children According to the National Asthma Education and Prevention Program at the National Institutes of Health, long-term controller medicines should be considered when infants or young children have had three or more episodes of wheezing in the previous 12 months and who are at an increased risk of developing asthma because of their own or their parents' history of allergic diseases.

They also recommend long-term controller medicines for children who need short-acting bronchodilators (rescue medicines) more than twice a week or have had severe asthma symptoms less than six weeks apart. Without a controller medicine, the underlying inflammation will continue to cause more asthma symptoms.

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Corticosteroids for acute severe asthma

corticosteroids for acute severe asthma

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