Scolaris Content Display Scolaris Content Display

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Forest plot of comparison: 1 Any ICS plus oral corticosteroid versus oral corticosteroid, outcome: 1.1 Asthma relapse at 7‐10 days.
Figures and Tables -
Figure 3

Forest plot of comparison: 1 Any ICS plus oral corticosteroid versus oral corticosteroid, outcome: 1.1 Asthma relapse at 7‐10 days.

Forest plot of comparison: 1 Any ICS plus oral corticosteroid versus oral corticosteroid, outcome: 1.5 Beta2‐agonist use at 20‐24 days.
Figures and Tables -
Figure 4

Forest plot of comparison: 1 Any ICS plus oral corticosteroid versus oral corticosteroid, outcome: 1.5 Beta2‐agonist use at 20‐24 days.

Forest plot of comparison: 2 Any ICS versus oral corticosteroid, outcome: 2.1 Asthma relapse at 7‐10 days.
Figures and Tables -
Figure 5

Forest plot of comparison: 2 Any ICS versus oral corticosteroid, outcome: 2.1 Asthma relapse at 7‐10 days.

Forest plot of comparison: 2 Any ICS versus oral corticosteroid, outcome: 2.2 Asthma relapse at 16‐21 days.
Figures and Tables -
Figure 6

Forest plot of comparison: 2 Any ICS versus oral corticosteroid, outcome: 2.2 Asthma relapse at 16‐21 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 1 Asthma relapse at 7‐10 days.
Figures and Tables -
Analysis 1.1

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 1 Asthma relapse at 7‐10 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 2 Asthma relapse at 20‐24 days.
Figures and Tables -
Analysis 1.2

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 2 Asthma relapse at 20‐24 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 3 Hospital admission.
Figures and Tables -
Analysis 1.3

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 3 Hospital admission.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 4 Beta2‐agonist use at 7‐10 days.
Figures and Tables -
Analysis 1.4

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 4 Beta2‐agonist use at 7‐10 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 5 Beta2‐agonist use at 20‐24 days.
Figures and Tables -
Analysis 1.5

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 5 Beta2‐agonist use at 20‐24 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 6 PEF at 7‐10 days.
Figures and Tables -
Analysis 1.6

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 6 PEF at 7‐10 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 7 PEF at 20‐24 days.
Figures and Tables -
Analysis 1.7

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 7 PEF at 20‐24 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 8 PEF% at 7‐10 days.
Figures and Tables -
Analysis 1.8

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 8 PEF% at 7‐10 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 9 PEF% at 20‐24 days.
Figures and Tables -
Analysis 1.9

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 9 PEF% at 20‐24 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 10 Quality of life at 7‐10 days.
Figures and Tables -
Analysis 1.10

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 10 Quality of life at 7‐10 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 11 Quality of life at 20‐24 days.
Figures and Tables -
Analysis 1.11

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 11 Quality of life at 20‐24 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 12 Cough at 7‐10 days.
Figures and Tables -
Analysis 1.12

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 12 Cough at 7‐10 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 13 Cough at 20‐24 days.
Figures and Tables -
Analysis 1.13

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 13 Cough at 20‐24 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 14 Wheeze at 7‐10 days.
Figures and Tables -
Analysis 1.14

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 14 Wheeze at 7‐10 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 15 Wheeze at 20‐24 days.
Figures and Tables -
Analysis 1.15

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 15 Wheeze at 20‐24 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 16 Dyspnoea at 7‐10 days.
Figures and Tables -
Analysis 1.16

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 16 Dyspnoea at 7‐10 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 17 Dyspnoea at 20‐24 days.
Figures and Tables -
Analysis 1.17

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 17 Dyspnoea at 20‐24 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 18 Hoarseness at 7‐10 days.
Figures and Tables -
Analysis 1.18

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 18 Hoarseness at 7‐10 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 19 Hoarseness at 20‐24 days.
Figures and Tables -
Analysis 1.19

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 19 Hoarseness at 20‐24 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 20 Sore throat at 7‐10 days.
Figures and Tables -
Analysis 1.20

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 20 Sore throat at 7‐10 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 21 Sore throat at 20‐24 days.
Figures and Tables -
Analysis 1.21

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 21 Sore throat at 20‐24 days.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 22 Asthma relapse at 7‐10 days ‐ gender subgroups.
Figures and Tables -
Analysis 1.22

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 22 Asthma relapse at 7‐10 days ‐ gender subgroups.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 23 Asthma relapse at 20‐24 days ‐ gender subgroups.
Figures and Tables -
Analysis 1.23

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 23 Asthma relapse at 20‐24 days ‐ gender subgroups.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 24 Asthma relapse at 7‐10 days; patients lost to follow‐up excluded.
Figures and Tables -
Analysis 1.24

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 24 Asthma relapse at 7‐10 days; patients lost to follow‐up excluded.

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 25 Asthma relapse at 20‐24 days; patients lost to follow‐up excluded.
Figures and Tables -
Analysis 1.25

Comparison 1 Any ICS plus oral corticosteroid versus oral corticosteroid, Outcome 25 Asthma relapse at 20‐24 days; patients lost to follow‐up excluded.

Comparison 2 Any ICS versus oral corticosteroid, Outcome 1 Asthma relapse at 7‐10 days.
Figures and Tables -
Analysis 2.1

Comparison 2 Any ICS versus oral corticosteroid, Outcome 1 Asthma relapse at 7‐10 days.

Comparison 2 Any ICS versus oral corticosteroid, Outcome 2 Asthma relapse at 16‐21 days.
Figures and Tables -
Analysis 2.2

Comparison 2 Any ICS versus oral corticosteroid, Outcome 2 Asthma relapse at 16‐21 days.

Comparison 2 Any ICS versus oral corticosteroid, Outcome 3 Hospital admission.
Figures and Tables -
Analysis 2.3

Comparison 2 Any ICS versus oral corticosteroid, Outcome 3 Hospital admission.

Comparison 2 Any ICS versus oral corticosteroid, Outcome 4 PEF at 7‐10 days.
Figures and Tables -
Analysis 2.4

Comparison 2 Any ICS versus oral corticosteroid, Outcome 4 PEF at 7‐10 days.

Comparison 2 Any ICS versus oral corticosteroid, Outcome 5 PEF at 16‐21 days.
Figures and Tables -
Analysis 2.5

Comparison 2 Any ICS versus oral corticosteroid, Outcome 5 PEF at 16‐21 days.

Comparison 2 Any ICS versus oral corticosteroid, Outcome 6 PEF% at 7‐10 days.
Figures and Tables -
Analysis 2.6

Comparison 2 Any ICS versus oral corticosteroid, Outcome 6 PEF% at 7‐10 days.

Comparison 2 Any ICS versus oral corticosteroid, Outcome 7 PEF% at 16‐21 days.
Figures and Tables -
Analysis 2.7

Comparison 2 Any ICS versus oral corticosteroid, Outcome 7 PEF% at 16‐21 days.

Comparison 2 Any ICS versus oral corticosteroid, Outcome 8 FEV1% pred at 6‐10 days (outcome not pre‐specified in original review).
Figures and Tables -
Analysis 2.8

Comparison 2 Any ICS versus oral corticosteroid, Outcome 8 FEV1% pred at 6‐10 days (outcome not pre‐specified in original review).

Comparison 2 Any ICS versus oral corticosteroid, Outcome 9 FEV1% pred at 16‐21 days (outcome not pre‐specified in original review).
Figures and Tables -
Analysis 2.9

Comparison 2 Any ICS versus oral corticosteroid, Outcome 9 FEV1% pred at 16‐21 days (outcome not pre‐specified in original review).

Comparison 2 Any ICS versus oral corticosteroid, Outcome 10 Beta2‐agonist use at 7‐10 days.
Figures and Tables -
Analysis 2.10

Comparison 2 Any ICS versus oral corticosteroid, Outcome 10 Beta2‐agonist use at 7‐10 days.

Comparison 2 Any ICS versus oral corticosteroid, Outcome 11 Beta2‐agonist use at 14‐21 days.
Figures and Tables -
Analysis 2.11

Comparison 2 Any ICS versus oral corticosteroid, Outcome 11 Beta2‐agonist use at 14‐21 days.

Comparison 2 Any ICS versus oral corticosteroid, Outcome 12 Quality of life at 7‐10 days.
Figures and Tables -
Analysis 2.12

Comparison 2 Any ICS versus oral corticosteroid, Outcome 12 Quality of life at 7‐10 days.

Comparison 2 Any ICS versus oral corticosteroid, Outcome 13 Cough at 7‐10 days.
Figures and Tables -
Analysis 2.13

Comparison 2 Any ICS versus oral corticosteroid, Outcome 13 Cough at 7‐10 days.

Comparison 2 Any ICS versus oral corticosteroid, Outcome 14 Wheeze at 7‐10 days.
Figures and Tables -
Analysis 2.14

Comparison 2 Any ICS versus oral corticosteroid, Outcome 14 Wheeze at 7‐10 days.

Comparison 2 Any ICS versus oral corticosteroid, Outcome 15 Wheeze at 16‐21 days.
Figures and Tables -
Analysis 2.15

Comparison 2 Any ICS versus oral corticosteroid, Outcome 15 Wheeze at 16‐21 days.

Comparison 2 Any ICS versus oral corticosteroid, Outcome 16 Hoarseness at 7‐10 days.
Figures and Tables -
Analysis 2.16

Comparison 2 Any ICS versus oral corticosteroid, Outcome 16 Hoarseness at 7‐10 days.

Comparison 2 Any ICS versus oral corticosteroid, Outcome 17 Hoarseness at 16‐21 days.
Figures and Tables -
Analysis 2.17

Comparison 2 Any ICS versus oral corticosteroid, Outcome 17 Hoarseness at 16‐21 days.

Comparison 2 Any ICS versus oral corticosteroid, Outcome 18 Sore throat at 7‐10 days.
Figures and Tables -
Analysis 2.18

Comparison 2 Any ICS versus oral corticosteroid, Outcome 18 Sore throat at 7‐10 days.

Comparison 2 Any ICS versus oral corticosteroid, Outcome 19 Sore throat at 16‐21 days.
Figures and Tables -
Analysis 2.19

Comparison 2 Any ICS versus oral corticosteroid, Outcome 19 Sore throat at 16‐21 days.

Summary of findings for the main comparison. Any ICS plus oral corticosteroid versus oral corticosteroid for acute asthma following emergency department discharge

Any ICS plus oral corticosteroid versus oral corticosteroid for acute asthma following emergency department discharge

Patient or population: predominantly adults with acute asthma following emergency department discharge
Settings: community following emergency department discharge
Intervention: any ICS plus oral corticosteroid versus oral corticosteroid

Comparison: oral corticosteroids

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Any ICS plus oral corticosteroid versus oral corticosteroid

Asthma relapse1at 20 to 24 days

141 per 1000

100 per 1000
(70 to 143)

OR 0.68
(0.46 to 1.02)

909
(3 studies)

⊕⊕⊕⊕
high2

Predominantly adult patients in Camargo 2000 and adults in

Brenner 2000

and

Rowe 1999

Hospital admission

mean follow‐up period 21 days

22 per 1000

22 per 1000
(9 to 55)

OR 0.99
(0.39 to 2.52)

805
(2 studies)

⊕⊕⊕⊝
moderate3

Predominantly adult patients in

Camargo 2000 and adult patients in

Rowe 1999

Hoarseness at 20 to 24 days

149 per 1000

95 per 1000
(59 to 150)

OR 0.6
(0.36 to 1.01)

596
(2 studies)

⊕⊕⊕⊝
moderate4

Predominantly adult patients in

Camargo 2000 and adult patients in

Rowe 1999

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI confidence interval; OR: odds ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 relapse was defined as "an unscheduled visit for worsening asthma symptoms".

2 No point deducted for imprecision as OR = 1.02 was not regarded as a clinically significant increase in risk of admission.

3 Point deducted for imprecision due to wide confidence intervals.

4 Point deducted for hoarseness at 20 to 24 days as I2 = 55%.

Figures and Tables -
Summary of findings for the main comparison. Any ICS plus oral corticosteroid versus oral corticosteroid for acute asthma following emergency department discharge
Summary of findings 2. Any ICS versus oral corticosteroid for acute asthma following emergency department discharge

Any ICS versus oral corticosteroid for acute asthma following emergency department discharge

Patient or population: patients with acute asthma following emergency department discharge
Settings:
Intervention: any ICS versus oral corticosteroid

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Any ICS versus oral corticosteroid

Asthma relapse1at 16 to 21 days

215 per
1000

257 per 1000
(180 to 353)

OR 1.26
(0.8 to
1.99)

425
(2 studies)

⊕⊕⊕⊝
moderate2

Adults in 1 study Levy 1996 and children in the
other Volovitz 1998

Hospital admission
mean follow‐up period:
9 to 10 days

8 per
1000

3 per 1000
(0 to 61)

OR 0.31
(0.01 to
7.95)

254
(3 studies)

⊕⊕⊕⊝
moderate2

Adults in 1 study Fitzgerald 2000 and children in the
other two Nakanishi 2003
and Volovitz 1998

Hoarseness at 16 to 21 days

24 per 1000

39 per 1000
(13 to 112)

OR 1.62
(0.52 to 5.05)

412
(1 study)

⊕⊕⊝⊝
low2,3

Adults in 1 study Levy 1996

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; OR: odds ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Relapse was defined in the largest study, Levy, as "treatment failure". Patients were categorised as a treatment failure if (a) PEF fell below 60% of the best/predicted value on two consecutive occasions, or (b) a symptom score of 3 (indicating the symptoms were the same or worse than on entry to the study) was recorded on three or more consecutive days, or (c) the patient withdrew because of uncontrolled symptoms or an adverse event related to asthma. In the other two studies relapse was defined as need for additional oral corticosteroid therapy or an unscheduled visit for asthma symptoms.

2 Point deducted for imprecision due to wide confidence intervals.

3 Point deducted for hoarseness at 16 to 21 days as data contributed by only one study.

Figures and Tables -
Summary of findings 2. Any ICS versus oral corticosteroid for acute asthma following emergency department discharge
Table 1. Summary of included studies comparing ICS plus oral corticosteroids to oral corticosteroids alone

Study

ICS + oral corticosteroids

N

Corticosteroids

N

Age

 

Location

Duration and delivery for ICS + corticosteroids

 

Duration and delivery for placebo + corticosteroids

 

Standard of care

Brenner 2000

28

35

Adults

 

US

 

Flunisolide 1 mg twice daily by MDI and aerochamber for 24 days

 

Placebo twice daily by MDI and aerochamber

 

Oral prednisone 40 mg daily for 5 days, and used albuterol MDI as needed

 

Camargo 2000

257

260

Predominantly adults

US

 

250 μg inhaled fluticasone by Diskhaler twice daily for 20 days

 

 

Placebo by Diskhaler twice daily for 20 days

 

Oral prednisone 50 mg daily for 5 days, and inhaled albuterol as needed

 

Rowe 1999

 

94

94

Adults

 

Canada

 

Inhaled budesonide Turbuhaler 800 μg twice daily for 3 weeks

 

Inhaled placebo Turbuhaler twice daily for 3 weeks

 

Both treatment and control groups received prednisone 50 mg PO x 7 days and prn salbutamol by MDI after discharge

 

ICS: inhaled corticosteroids; MDI: metered‐dose inhaler; PO: oral.

Figures and Tables -
Table 1. Summary of included studies comparing ICS plus oral corticosteroids to oral corticosteroids alone
Table 2. Summary of included studies comparing ICS alone to oral corticosteroid alone

Study

ICS

N

Corticosteroids

N

Age

Location

Duration and delivery for ICS

Duration and delivery for corticosteroids

Standard of care

Di Franco 2006

18

19

Adults

Italy

Inhaled fluticasone propionate (FP) 2000 mg/daily (4 puffs of 250 mg in the morning and in the evening with a large spacer) and oral prednisone placebo for 2 weeks

Oral prednisone 40 mg/day tapered to 10 mg/day by reducing the dose by 5 mg every other day and inhaled placebo for 2 weeks. Patients held their usual regular ICS treatment but continued to use their previous regular bronchodilator treatment (including oral theophylline), during the study period

Fitzgerald 2000

90

85

Adults

Canada

Budesonide 600 μg 4 times daily by Turbuhaler for 7 to 10 days (mean 7.5 days)

Oral prednisone, 40 mg daily, for 7 to 10 days (mean 7.5 days)

Participants used inhaled terbutaline as needed and pre‐existing asthma medications were continued

Francis 1997

37

19

Children

Multicentre study based in the UK

Inhaled fluticasone propionate, 1 mg twice daily by nebuliser, and placebo oral suspension for 7 days

Inhaled placebo twice daily, and oral prednisolone 2 mg/kg/day for 4 days, then 1 mg/kg/day for 3 days

Both groups received salbutamol as needed, by nebuliser or MDI with babyhaler. Concurrent medications were continued (4 patients only)

Levy 1996

200

203

Adults

UK

Fluticasone 1 mg twice daily via a Volumatic for a period of 16 days

Reducing course of oral prednisolone, starting at 40 mg and reducing by 5 mg every 2 days, for a period of 16 days

All concurrent asthma medications, including existing ICS, were continued

Manjra 2000

158

151

Children

multicentre study based in the UK

Fluticasone propionate, 1 mg twice daily by nebuliser for 7 days and oral placebo

Inhaled placebo, and oral prednisolone, 2 mg/kg/day for 4 days, then 1 mg/kg/day for 3 days

Both groups received inhaled salbutamol as needed, and concurrent medications were continued

Nakanishi 2003

29

28

Children

US

Flunisolide, 4 inhalations (1 mg) twice daily for 7 days, and daily placebo tablets

Oral prednisone, 2 mg/kg (maximum of 60 mg/day) for 7 days and inhaled placebo twice daily. Outpatient inhalations were given with a pressurised MDI with valved holding chamber

Nana 1998

42

42

Adults

Thailand

Inhaled budesonide by Turbuhaler, 1600 mg twice daily for 7 days, and oral placebo

Oral prednisolone initially 40 mg per day and decreasing by 5 mg/day for 7 days, and inhaled placebo

Both groups received 1 dose of oral prednisolone 60 mg PO while in the emergency department, and inhaled terbutaline by Turbuhaler as needed. Other asthma medications were continued during the study (48 patients were on oral xanthines and 49 patients were on oral beta2‐agonists)

Verona 1998

62

74

Children

Multicentre study based in the UK

Fluticasone propionate (FP) 500 μg twice daily by MDI with spacer for 7 days, and placebo tablets

Prednisolone tablets, 2 mg/kg/day for 4 days, 1 mg/kg/day for 3 days, and placebo MDI inhaler

All patients received Ventolin as needed, and continued all regular asthma medications

Volovitz 1998

11

11

Children 

Israel

Single‐dose budesonide 1600 μg by turbohaler

 

Prednisolone 2 mg/kg PO

Both groups received terbutaline 5 mg by nebuliser or 0.5 mg by turbohaler at the start of trial. Intervention 1 group was discharged on budesonide 200 μg 4 times daily by turbohaler, reduced by 25% every second day, and placebo tablets. From the eighth day, they continued on 200 μg twice daily for 2 weeks. Intervention 2 group was discharged on prednisolone 2 mg/kg/day, reduced by 25% every second day, and placebo Tubohaler

 

ICS: inhaled corticosteroid; MDI: metered‐dose inhaler; PO: oral.

Figures and Tables -
Table 2. Summary of included studies comparing ICS alone to oral corticosteroid alone
Comparison 1. Any ICS plus oral corticosteroid versus oral corticosteroid

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Asthma relapse at 7‐10 days Show forest plot

3

909

Odds Ratio (M‐H, Fixed, 95% CI)

0.72 [0.48, 1.10]

2 Asthma relapse at 20‐24 days Show forest plot

3

909

Odds Ratio (M‐H, Fixed, 95% CI)

0.68 [0.46, 1.02]

3 Hospital admission Show forest plot

2

805

Odds Ratio (M‐H, Fixed, 95% CI)

0.99 [0.39, 2.52]

4 Beta2‐agonist use at 7‐10 days Show forest plot

3

672

Mean Difference (IV, Fixed, 95% CI)

0.51 [‐0.44, 1.47]

5 Beta2‐agonist use at 20‐24 days Show forest plot

3

602

Mean Difference (IV, Random, 95% CI)

‐0.14 [‐2.35, 2.06]

6 PEF at 7‐10 days Show forest plot

2

205

Mean Difference (IV, Fixed, 95% CI)

‐0.88 [‐28.49, 26.72]

7 PEF at 20‐24 days Show forest plot

2

172

Mean Difference (IV, Fixed, 95% CI)

‐4.55 [‐35.91, 26.81]

8 PEF% at 7‐10 days Show forest plot

2

206

Mean Difference (IV, Random, 95% CI)

‐1.79 [‐11.04, 7.46]

9 PEF% at 20‐24 days Show forest plot

2

172

Mean Difference (IV, Random, 95% CI)

‐2.34 [‐9.44, 4.77]

10 Quality of life at 7‐10 days Show forest plot

2

613

Mean Difference (IV, Fixed, 95% CI)

0.19 [‐0.01, 0.39]

11 Quality of life at 20‐24 days Show forest plot

2

559

Mean Difference (IV, Random, 95% CI)

0.33 [‐0.36, 1.01]

12 Cough at 7‐10 days Show forest plot

2

620

Mean Difference (IV, Random, 95% CI)

‐0.25 [‐0.57, 0.07]

13 Cough at 20‐24 days Show forest plot

2

571

Mean Difference (IV, Random, 95% CI)

‐0.47 [‐1.25, 0.31]

14 Wheeze at 7‐10 days Show forest plot

2

622

Mean Difference (IV, Random, 95% CI)

‐0.18 [‐0.48, 0.12]

15 Wheeze at 20‐24 days Show forest plot

2

571

Mean Difference (IV, Random, 95% CI)

‐0.43 [‐1.31, 0.45]

16 Dyspnoea at 7‐10 days Show forest plot

2

620

Mean Difference (IV, Random, 95% CI)

‐0.29 [‐0.92, 0.33]

17 Dyspnoea at 20‐24 days Show forest plot

2

571

Mean Difference (IV, Random, 95% CI)

‐0.43 [‐1.31, 0.45]

18 Hoarseness at 7‐10 days Show forest plot

2

612

Odds Ratio (M‐H, Fixed, 95% CI)

0.88 [0.53, 1.46]

19 Hoarseness at 20‐24 days Show forest plot

2

596

Odds Ratio (M‐H, Fixed, 95% CI)

0.60 [0.36, 1.01]

20 Sore throat at 7‐10 days Show forest plot

2

612

Odds Ratio (M‐H, Fixed, 95% CI)

0.73 [0.43, 1.24]

21 Sore throat at 20‐24 days Show forest plot

2

596

Odds Ratio (M‐H, Fixed, 95% CI)

0.64 [0.35, 1.16]

22 Asthma relapse at 7‐10 days ‐ gender subgroups Show forest plot

3

720

Odds Ratio (M‐H, Random, 95% CI)

0.76 [0.38, 1.52]

22.1 Male

3

296

Odds Ratio (M‐H, Random, 95% CI)

0.96 [0.21, 4.43]

22.2 Female

3

424

Odds Ratio (M‐H, Random, 95% CI)

0.79 [0.34, 1.82]

23 Asthma relapse at 20‐24 days ‐ gender subgroups Show forest plot

3

761

Odds Ratio (M‐H, Random, 95% CI)

0.71 [0.37, 1.35]

23.1 Male

3

315

Odds Ratio (M‐H, Random, 95% CI)

0.60 [0.22, 1.62]

23.2 Female

3

446

Odds Ratio (M‐H, Random, 95% CI)

0.78 [0.30, 1.99]

24 Asthma relapse at 7‐10 days; patients lost to follow‐up excluded Show forest plot

3

725

Odds Ratio (M‐H, Fixed, 95% CI)

0.72 [0.47, 1.10]

25 Asthma relapse at 20‐24 days; patients lost to follow‐up excluded Show forest plot

3

768

Odds Ratio (M‐H, Fixed, 95% CI)

0.70 [0.46, 1.05]

Figures and Tables -
Comparison 1. Any ICS plus oral corticosteroid versus oral corticosteroid
Comparison 2. Any ICS versus oral corticosteroid

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Asthma relapse at 7‐10 days Show forest plot

4

684

Odds Ratio (M‐H, Fixed, 95% CI)

1.00 [0.66, 1.52]

2 Asthma relapse at 16‐21 days Show forest plot

2

425

Odds Ratio (M‐H, Fixed, 95% CI)

1.26 [0.80, 1.99]

3 Hospital admission Show forest plot

3

254

Odds Ratio (M‐H, Fixed, 95% CI)

0.31 [0.01, 7.95]

4 PEF at 7‐10 days Show forest plot

6

1047

Mean Difference (IV, Fixed, 95% CI)

10.95 [‐0.84, 22.73]

5 PEF at 16‐21 days Show forest plot

4

792

Mean Difference (IV, Fixed, 95% CI)

15.21 [1.53, 28.89]

6 PEF% at 7‐10 days Show forest plot

2

376

Mean Difference (IV, Fixed, 95% CI)

‐0.74 [‐3.12, 1.64]

7 PEF% at 16‐21 days Show forest plot

2

347

Mean Difference (IV, Fixed, 95% CI)

0.58 [‐2.07, 3.23]

8 FEV1% pred at 6‐10 days (outcome not pre‐specified in original review) Show forest plot

1

55

Mean Difference (IV, Fixed, 95% CI)

‐17.80 [‐26.98, ‐8.62]

9 FEV1% pred at 16‐21 days (outcome not pre‐specified in original review) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

10 Beta2‐agonist use at 7‐10 days Show forest plot

3

128

Mean Difference (IV, Fixed, 95% CI)

0.08 [‐0.47, 0.64]

11 Beta2‐agonist use at 14‐21 days Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

12 Quality of life at 7‐10 days Show forest plot

2

231

Std. Mean Difference (IV, Fixed, 95% CI)

0.14 [‐0.12, 0.40]

13 Cough at 7‐10 days Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

14 Wheeze at 7‐10 days Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

15 Wheeze at 16‐21 days Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

16 Hoarseness at 7‐10 days Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

17 Hoarseness at 16‐21 days Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

18 Sore throat at 7‐10 days Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

19 Sore throat at 16‐21 days Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

Figures and Tables -
Comparison 2. Any ICS versus oral corticosteroid