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There was no difference in their peak flow measurements 24 h after admission. GINA and the EPR3 guidelines prefer oral administration because it is less invasive except in patients with absorption problems or those who are not able to take orally due to the severity of their respiratory distress or because they are vomiting. Prescribing a short course of oral corticosteroids following the ED treatment of acute asthma exacerbations was found to reduce the rate of relapse. The use of ICS in the treatment of acute asthma was studied in four contexts: In comparison to placebo, In comparison to systemic corticosteroids, As add on therapy to systemic steroids with continuation after discharge from the ED, or. As add on therapy to systemic steroids within the ED stay period only. In the first context, a systematic review that looked at eight randomized and blinded studies comparing the efficacy of ICS to placebo in acute asthma exacerbation suggested that ICS are superior to placebo especially when given at high doses (>1 mg of budesonide or fluticasone) and to patients with severe exacerbations. In addition, a recent study found that preemptive use of high dose fluticasone (750 mcg BID) at the onset of an upper respiratory tract infection in children with recurrent virus induced wheezing and continuing it for 10 days, reduced the use of rescue oral corticosteroids. Some studies reported superiority of systemic steroids in reducing admission rate, some reported equal efficacy in relation to admission rate as well,[59,60,61] and some reported superiority of ICS. In this context, Rowe et al. One study looked at the addition of high dose beclomethasone versus placebo to methylprednisolone in 60 adults and found no difference in FEV 1 or symptoms between the two groups. However, the patient number included was very small and PEFR is generally not reliable in young children. Both groups had no difference in the pulmonary index score. In the other study by Upham et al. There was no difference in the asthma score at 2 h after intervention or in the admission rate or time to discharge from the ED between the two groups. Collectively, it was hard to come up with a conclusion from these studies about whether adding ICS to systemic steroids in standard acute asthma therapy will add more benefit or not. Therefore, we recently performed a larger blinded and randomized study to look at this question. However, when we looked at only the subgroup with severe acute asthma, budesonide was able to significantly decrease the admission rate of those patients and to lower their asthma score, suggesting an added value. More large trials specifically targeting patients with severe acute asthma are clearly needed. Corticosteroids play an important role in the treatment of acute asthma exacerbations in the ED as well as post discharge from the ED. Further research is greatly needed to shed more light on the use of ICS in those patients, their optimal dose and duration, as well as their concomitant use with systemic corticosteroids. In addition, more research is needed on the safety of dispensing oral corticosteroids for home use in case of asthma exacerbation, cypionat 250 mg injectable steroids testosterone cypionate. This review was modified and updated from a chapter entitled ‘The use of glucocorticoids in the treatment of acute asthma exacerbations’ by the same author in ‘Corticosteroids-new recognition of our familiar friend’ edited by Xiaoxiao Qian, 2012. The author holds exclusive copyright to this chapter. This work was supported by a grant from the Program of Strategic Technologies of the National Plan for Science and Technology and Innovation, Saudi Arabia. Source of Support: This work was supported by a grant from the Program of Strategic Technologies of the National Plan for Science and Technology and Innovation, Saudi Arabia.
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