Adding an inhaler to Emergency Department care could reduce asthma admissions by 27%

Comic illustrated by Dr Ciléin Kearns.

Around 1 in 6 New Zealanders (around 830,000) have asthma, a bit above the world average which is 10-15% of adults. Asthma attacks are a common and important reason for patients with asthma to attend the emergency department (ED). Many of these people need to be admitted into hospital for ongoing treatment.

Standard treatments for acute asthma in the ED include medicines to open up the airways (like salbutamol), and steroids given through a vein or as a tablet to reduce inflammation in the airways. These are called systemic corticosteroids (SCS). We wanted to find out if giving inhaled steroids (ICS) in addition to standard treatment could help patients with an acute asthma attack.

Our team did a systematic review and meta-analyses to find out if adding an ICS to existing standard treatment for acute asthma with SCS, changed the rate of hospitalization from the ED. Systematic reviews involve searching the medical literature to find all studies that address a specific research question. This results in a detailed summary of the current evidence. Meta-analysis is the statistical approach of combining data from multiple studies to analyse as one big study. The results of a meta-analysis are stronger than the results of any individual study by itself.

This review included 25 studies involving 2733 participants. There was moderate evidence that high doses of ICS, in addition to SCS, reduced the risk of hospital admission by approximately 27% in the ED treatment of moderate-to-severe asthma exacerbations. That’s about 1 in every 4 patients who was able to go home, instead of needing to be admitted to hospital.

To put into perspective, the use of ipratropium bromide (a widely used medication for acute asthma in the ED) reduces the risk of hospital admission by approximately 28%. In addition there was moderate evidence of an improvement in clinical scores and vital signs with ICS in addition to SCS. Relatively few studies reported adverse events.

The authors propose that ICS can be recommended for use in addition to SCS in the ED treatment of severe exacerbations of asthma. Further research will help to figure out the optimal role in both the ED and outpatient settings.

If you have Institutional Access you can view the full paper published in the Journal of Allergy and Clinical Immunology: In Practice here: http://bit.ly/ICS-systematic-rv