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Adding nebulized to systemic corticosteroids for acute asthma in children: a meta-analysis
  • +2
  • Jose Castro-RodriguezOrcid,
  • Mauricio Pincheira,
  • Diana Escobar-Serna,
  • Monica Sossa-Briceño,
  • Carlos Rodriguez-Martinez
Jose Castro-Rodriguez
Orcid
Pontificia Universidad Catolica de Chile
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Mauricio Pincheira
Pontificia Universidad Catolica de Chile
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Diana Escobar-Serna
Universidad Nacional de Colombia
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Monica Sossa-Briceño
Universidad Nacional de Colombia
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Carlos Rodriguez-Martinez
School of Medicine, Universidad El Bosque
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Peer review status:ACCEPTED

13 May 2020Submitted to Pediatric Pulmonology
13 May 2020Submission Checks Completed
13 May 2020Assigned to Editor
15 May 2020Reviewer(s) Assigned
28 May 2020Review(s) Completed, Editorial Evaluation Pending
01 Jun 2020Editorial Decision: Revise Major
29 Jun 20201st Revision Received
30 Jun 2020Assigned to Editor
30 Jun 2020Submission Checks Completed
30 Jun 2020Reviewer(s) Assigned
03 Jul 2020Review(s) Completed, Editorial Evaluation Pending
08 Jul 20202nd Revision Received
09 Jul 2020Assigned to Editor
09 Jul 2020Reviewer(s) Assigned
09 Jul 2020Submission Checks Completed
10 Jul 2020Review(s) Completed, Editorial Evaluation Pending
10 Jul 2020Editorial Decision: Accept

Abstract

International guidelines have recommended the use of inhaled beta-2 agonists and systemic corticosteroids (SC) as the first-line treatment for acute asthma. Objective: To evaluate the evidence for the efficacy of inhaled corticosteroids (ICS) in addition to SC compared to SC alone in children with acute asthma in the ED or during hospitalization. Data sources: Five electronic databases were searched. Study Selection: All RCTs that compared ICS (via nebulizer or metered dose inhaler) plus SC (oral or parenteral) with placebo (or standard care) plus SC were included without language restriction. Data extraction: Two reviewers independently reviewed all studies. The primary outcomes were hospital admission or hospital length of stay [LOS], and secondary outcomes were readmissions during follow-up, ED-LOS, lung function, asthma clinical score, oxygen saturation, and heart and respiratory rates. Results: Nine studies (n=1473) met the inclusion criteria. In all the studies, the ICS was budesonide. Compared to SC alone, adding budesonide to SC did not affect hospitalization rate, but decreased hospital LOS by more than one day (MD= -29.08 hours [-39.9 to -18.3]; I2=0%, p=<0.00001). Moreover, adding budesonide (especially with ≥2mg doses) significantly improved the acute asthma severity score among patients at ED. Conclusions: Compared to SC alone, adding budesonide to SC did not affect hospitalization rate, but decreases the LOS and improves the acute asthma score in children at ED setting.