CLINICAL QUESTION

Which oral corticosteroid regimen is most effective in children with acute asthma exacerbations?

BOTTOM LINE

Based on the network meta-analysis, there is no significant difference among various regimens of dexamethasone or prednisolone in preventing relapses in children with acute asthma exacerbations. A key limitation is the authors' failure to report data on harms of the different regimens. (Level of Evidence = 1a−)

SYNOPSIS

The authors searched several databases and registries to identify 11 randomized trials conducted in outpatient or emergency department settings that compared various oral corticosteroid regimens in 2,353 children with acute asthma exacerbations. They did not include trials that used placebo or other nonsteroid comparators. The authors reported that three studies were at high risk of bias and four were at low risk of bias. The studies included 15 comparisons of six different regimens (all using dexamethasone or prednisolone). The primary outcome was an unplanned visit to an emergency department or primary care facility within 14 days of the initial encounter. Despite the spotty risk of bias in the included studies, the authors conducted a network meta-analysis to determine the comparative effectiveness of each regimen and found no significant difference. As in many of these analyses, the authors report no data on adverse events; they bury the raw data for vomiting in an appendix without mentioning it in the main paper. Overall, the authors have very low confidence in the results, including the data on vomiting.