Evaluating the effectiveness of systemic corticosteroids to mitigate relapse in children assessed and treated for acute asthma: A network meta-analysis

ABSTRACT

Objective: The objective of this systematic review was to explore the effectiveness of various systemic corticosteroid (SCS) regimens to mitigate relapse in children with asthma discharged from an acute care setting. Data Sources: Medline, EMBASE, Global Health, International Pharmaceutical Abstracts, EMB ALL, CINAHL, SCOPUS, Proquest Dissertations and Theses Global, and LILACS were searched using controlled vocabulary and key words. Additional citations were searched via clinical trial registries, Google Scholar, bibliographies, a SCOPUS forward search of a sentinel paper, and hand searching conference abstracts. Study Selection: No limitations based on language, publication status, or year of publication were applied. Two independent reviewers searched to identify randomized controlled trials comparing the effectiveness of SCS regimens to prevent relapse in children following treatment for acute asthma. Results: Fifteen studies were included. In 3 studies comparing SCS to placebo, asthma relapse was significantly reduced (RR = 0.10; 95% CI: 0.01, 0.77; I² = 0%). A network analysis identified a significant reduction in relapse in children treated with intramuscular corticosteroids (OR = 0.038; 95% CrI: 0.001, 0.397), short-course oral prednisone (OR = 0.054; 95% CrI: 0.002, 0.451), and oral dexamethasone (OR = 0.071; 95% CrI: 0.002, 0.733) compared to placebo. Conclusion: This review found evidence that SCS reduces relapse in children following treatment for acute asthma, albeit based on a limited number of studies. Additional studies are required to assess the differential effect of SCS doses and treatment duration to prevent relapse in children following discharge for acute asthma.

KEYWORDS:

• Dexamethasone
• emergency department
• prednisone
• randomized controlled trials
• systematic review

Acknowledgements

The authors would like to thank Drs. Chang, Cronin, Ghafouri, Grant, Klig, Greenberg, and Sharieff for responding to their requests for additional information. We would also like to thank Drs. Elfriede Cross (EC) and Tariq AlShawabkeh (TA) (Department of Emergency Medicine, University of Alberta) for their assistance with screening, study quality assessment, and data extraction. We would also like to thank Lynette Krebs (Department of Emergency Medicine, University of Alberta) for her feedback on the manuscript. Finally, we would like to thank Elizabeth Stovold for providing the search from the Cochrane Airways Group.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Additional information

Funding

This review was supported by a grant from the Canadian Institutes of Health Research (CIHR; 250480). In-kind resources were provided by the Emergency Medicine Research Group (EMeRG) affiliated with the Department of Emergency Medicine, University of Alberta. SWK is supported by the Emergency Strategic Clinical Network. At the time of the research, CVR was supported by CIHR in partnership with the Knowledge Translation branch. AN is supported by the CIHR as a CIHR New Investigator. FMD's research is supported by the Fonds de la Recherche en Santé du Québec which provides infrastructure support to the Research Institutes of the Sainte-Justine University Health Centre. BHR's research is supported by a Tier I Canada Research Chair in Evidence-based Emergency Medicine from CIHR through the Government of Canada (Ottawa, Ontario). The funders take no responsibility for the conduct, results, and conclusions of this review.