The technique of meta-analysis has been used to deal with these variations in the published literature, so that the results of many clinical trials can be pooled to give a single measure of effect. The literature therefore contains some trials showing that corticosteroids have no effect. There can be resolution with bronchodilators alone, a delayed response to corticosteroid, or treatment failure with no response to corticosteroid. This may relate to the type of trigger, the presence (or absence) of corticosteroid responsive pathology (eosinophilic bronchitis) versus the degree of mucus plugging. The clinical course of an asthma exacerbation varies from one patient to another. Corticosteroids are particularly important in step 2, 'How to increase treatment'.Ĭorticosteroids are generally considered to be beneficial in exacerbations of asthma, although some studies have found minimal or no benefit. for how long to take the increased treatmentįailure to specify and adhere to each component of the action plan can result in treatment failure.This approach needs to be defined individually for each person with asthma, and written down as an action plan. The main approach is the early use of sufficient corticosteroid and bronchodilator therapy to reverse the exacerbation. When a patient presents with acute asthma, this is an important occasion to review background asthma control, and to provide the patient with an asthma action plan. This provides an opportunity to intervene early in order to reduce the severity of the exacerbation. In most cases the exacerbation progressively worsens over several days, or occurs on a background of chronic poor asthma control. Specific therapy is not available for the poorly understood mucus plugging. Corticosteroids are of proven benefit for eosinophilic airway inflammation, and bronchodilators are given to reverse bronchospasm. The aims of treatment are to prevent death, to relieve hypoxaemia, to normalise lung function as quickly as possible, and to prevent future relapses. Recognised triggers for asthma exacerbations include respiratory tract infections, allergens, occupational chemical exposure and non-specific triggers such as irritants and emotional factors. airway inflammation with cellular infiltration and oedema.Clinical guidelines are attempting to standardise the approach to management, but they still have their problems. There are probably as many corticosteroid regimens as there are physicians treating asthma. Although corticosteroids have been used for symptomatic exacerbations of asthma for many years, there is considerable variability in how they are used. The dose, route and duration of therapy need to be defined for each patient and written down as part of an action plan to enable early intervention in future exacerbations.Īn exacerbation of asthma is a common and sometimes life -threatening complication which may require hospital admission. There is an increasing role for inhaled corticosteroids in the management of mild exacerbations of asthma. Therapy does not need to be tapered, but can be ceased abruptly after 10 days in most patients who are also taking high -dose inhaled corticosteroids. Corticosteroids should be given twice a day for optimum effect. Oral prednisolone is as effective as intravenous therapy and very high doses of corticosteroid are no better than modest doses (30-50 mg prednisolone). Much of the current variation in clinical practice is not justified by data from clinical trials. Cortico steroids are essential to reverse the eosinophilic airway inflammation which causes symptomatic exacerbations of asthma.
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