Corticosteroids for acute severe asthma in hospitalised patientsAsthma is a chronic inflammatory disease, corticosteroids severe asthma is characterised by reversible corticosteroids severe asthma obstruction in response to astgma variety of stimuli. Exacerbations in response to airway irritants are part of the natural history of asthma, but often they also represent a failure in chronic treatment. Presentations to emergency departments and other acute care settings are common and frequently lead to hospitalisation and other complications. After treatment, however, most patients are discharged to the care of their primary care physician for further management. This review highlights the role of systemic and inhaled corticosteroids as mainstays of treatment in mast cell pharmaceuticals inc acute and sub-acute phase of an exacerbation. These agents form the basis of most current clinical corticosteroids severe asthma guidelines, yet their use is not universal. We will review the evidence for the use of these agents that arises from the Cochrane Collaboration of Systematic Reviews contained in the Cochrane Library.
Starting systemic corticosteroid treatment | Australian Asthma Handbook
Short courses of systemic corticosteroids are used to manage flare-ups and acute asthma. Parenteral corticosteroids are sometimes used to manage severe acute asthma in emergency departments. Occasionally, longer-term use of oral corticosteroids is necessary to manage difficult-to-treat asthma under specialist supervision.
Warn patients not to take more inhalations or more frequent doses. Before prescribing any medicine, check the Therapeutic Goods Administration-approved product information. Pharmaceutical Benefits Scheme criteria for some asthma medicines differ between age groups and indications. Short courses of oral corticosteroids initiated by parents in response to the onset of wheezing symptoms do not appear to reduce the need for hospitalisation or treatment in the emergency department for preschool children.
A short course of oral corticosteroid may be helpful in gaining rapid asthma control, with a low risk of additional systemic adverse effects. Rarely, long-term systemic corticosteroids may be needed for children with severe persistent asthma that is poorly controlled despite high-dose inhaled corticosteroids and long-acting beta 2 agonists. A short course of oral corticosteroid therapy less than 2 weeks is associated with little risk of long-term suppression of the hypothalamus—pituitary—adrenal axis.
Recurrent courses of oral corticosteroids may also affect bone mineral density, especially in boys. In children aged 6—14 years, a course of oral prednisolone initiated by parents in response to an asthma flare-up may reduce asthma symptoms and the number of missed school days.
In children aged 1—5 years with episodic wheezing, oral corticosteroids are not effective in managing the symptoms of acute lower respiratory tract illnesses. The use of oral corticosteroids is accepted as part of the management of severe asthma flare-ups, including in most asthma clinical trials.
Most clinical trials that have specifically evaluated the use of oral corticosteroids to manage flare-ups have been conducted in patients attending emergency departments. Oral corticosteroids courses of 5—10 days are effective in regaining control of asthma after an acute flare-up. Abruptly ceasing oral prednisolone after a short course appears to be equally effective as tapering over a longer period.
Tapering the dose does not reduce the risk of suppression of adrenal function. Action plans for worsening asthma that include instructions for the use of oral corticosteroids as well as instructions to increase the dose of inhaled corticosteroid, are effective in improving lung function and reducing hospital admissions.
Systemic corticosteroids given within 1 hour of presentation to an emergency department reduce the need for hospital admission in patients with acute asthma, particularly if they have severe asthma or are not already taking systemic corticosteroids.
Oral prednisolone is as effective as intravenous or intramuscular corticosteroids during acute asthma in adults. Higher doses do not appear to be more effective in adults with acute asthma. After an acute asthma episode, a short course of systemic corticosteroids reduces the risk of relapse, hospitalisations, and use of short-acting beta 2 -agonist, and appears to be well tolerated. A course of 5—10 days is sufficient. The recommendation in this Handbook for a maximum prednisolone dose of 50 mg for children is based on practical considerations, taking into account commercially available doses and strengths and consistency with the dose recommended for adults.
Short-term use of oral corticosteroids is unlikely to cause harm — the majority of adverse effects are due to long-term high-dose use. High doses can be associated with behavioural changes, facial plethora, bruising and increased sweating. In people with diabetes or impaired glucose tolerance, corticosteroids increase blood glucose levels.
Impaired glucose tolerance is common among people aged over 65 years. In patients with diabetes or impaired glucose tolerance, blood glucose monitoring e.
Systemic corticosteroids can have a range of psychological effects. Large doses of prednisone or prednisolone can cause mood and behavioural changes, including nervousness, euphoria or mood swings, psychotic episodes including manic or depressive states, paranoid states and acute toxic psychoses. Systemic corticosteroid treatment has been associated with elevated mood and reduction in depression among patients with asthma. Peak plasma level of systemic corticosteroid occurs at approximately 2 hours post dose, so peak milk level will also occur around this time.
With high maternal doses, avoiding breastfeeding for 4 hours after a dose should markedly decrease the dose received by the infant. However, this [manoeuvre] is probably not necessary in most cases. National Asthma Council Australia. Recommendation types Quick Reference Guide. Home Resources Medicines guide Systemic corticosteroids.
Guide to systemic corticosteroids Overview Short courses of systemic corticosteroids are used to manage flare-ups and acute asthma. Classification of asthma medicines Opens in a new window Please view and print this figure separately: Classification of asthma medicines Classification of asthma medicines. Notes Before prescribing any medicine, check the Therapeutic Goods Administration-approved product information.
More information Oral corticosteroids for children: Managing acute asthma in clinical settings Close Oral corticosteroids for children: Close Systemic corticosteroids in acute asthma: Definition, assessment and treatment of wheezing disorders in preschool children: Efficacy of a short course of parent-initiated oral prednisolone for viral wheeze in children aged years: Oral prednisolone for preschool children with acute virus-induced wheezing. N Engl J Med.
The role of corticosteroids in the management of childhood asthma. Parent-initiated oral corticosteroid therapy for intermittent wheezing illnesses in children. Cochrane Database Syst Rev. Parent initiated prednisolone for acute asthma in children of school age: Do oral corticosteroids reduce the severity of acute lower respiratory tract illnesses in preschool children with recurrent wheezing?.
J Allergy Clin Immunol. A pilot study of steroid therapy after emergency department treatment of acute asthma: Duration of systemic corticosteroids in the treatment of asthma exacerbation; a randomized study.
Prospective, placebo-controlled trial of 5 vs 10 days of oral prednisolone in acute adult asthma. Double-blind trial of steroid tapering in acute asthma. Corticosteroids for preventing relapse following acute exacerbations of asthma.
Written action plans for asthma: Early emergency department treatment of acute asthma with systemic corticosteroids. Observational study of intravenous versus oral corticosteroids for acute asthma: Oral versus intravenous corticosteroids in adults hospitalised with acute asthma.
A comparative efficacy of oral prednisone with intramuscular triamcinolone in acute exacerbation of asthma. Iran J Allergy Asthma Immunol. Corticosteroids for acute severe asthma in hospitalised patients. Panafcort prednisone and Panafcortelone prednisolone. Therapeutic Goods Administration, Canberra, Early use of inhaled corticosteroids in the emergency department treatment of acute asthma.
Mood changes during prednisone bursts in outpatients with asthma. Randomized, double-blind, placebo-controlled trial of acetaminophen for preventing mood and memory effects of prednisone bursts.
Effects of chronic prednisone therapy on mood and memory. Manual of Lactational Pharmacology. Hale Publishing, Amarillo, Managing asthma in adults Exercise and asthma. Managing asthma in children Asthma in pregnant women. Managing acute asthma in adults and children.