Summary of findings for the main comparison. ICS versus placebo.
| ICS versus placebo | ||||||
|
Patient or population: people with acute asthma
Settings: emergency department
Intervention: ICS therapy Control: placebo | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | ICS therapy | |||||
| Hospital admission | 316 per 1000 | 169 per 1000 (125 to 220) | OR 0.44 (0.31 to 0.61) | 959 (12 studies) | ⊕⊕⊝⊝ low1 | There was conflicting evidence from the studies of ICS in addition to systemic corticosteroids (I2 = 52%) |
| FEV1 at 1 hour | The mean FEV1 ranged from 1.41 to 2.17 L | The mean FEV1 at 1 hour in the intervention groups was 0.28 L higher (0.22 lower to 0.77 higher) | MD 0.28 (95% CI ‐0.22 to 0.77) |
248 (4 studies) | ⊕⊕⊝⊝ low2 | |
| FEV1 at 3 to 4 hours | The mean FEV1 ranged from 1.7 to 2.1 L | The mean FEV1 at 3 to 4 hours in the intervention groups was 0.15 L higher (0.09 lower to 0.39 higher) | MD 0.15 (95% CI ‐0.09 to 0.39) |
319 (4 studies) | ⊕⊕⊕⊝ moderate3 | |
| Adverse effects ‐ nausea/vomiting | 64 per 1000 | 21 per 1000 (2 to 178) | OR 0.32 (0.03 to 3.18) | 94 (1 study) | ⊕⊕⊝⊝ low4 | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; FEV1: forced expiratory volume in one second; OR: odds ratio. | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 Point deducted in hospital admissions due to variability in risk of bias among contributing trials and a point deducted due to heterogeneity.
2 Point deducted in FEV1 at 1 hour due to variability in risk of bias among contributing trials, and an additional point deducted for the very high level of heterogeneity (I2 = 90%).
3 Point deducted in FEV1 at 3 to 4 hours due to heterogeneity (I2 = 55%).
4 2 points deducted due to wide CI and only one study contributing to outcome.