Summary of findings 3. Children: higher dose/longer course compared with lower dose/shorter course for acute asthma.
| Children: higher dose/longer course compared with lower dose/shorter course for acute asthma | ||||||
|
Patient or population: children with an acute exacerbation of asthma
Setting: inpatient or community
Intervention: higher dose/longer course of oral steroids
Comparison: lower dose/shorter course of oral steroids Duration range: 1 to 4 weeks | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | Number of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with lower dose/shorter course | Risk with higher dose/longer course | |||||
| Re‐admission during follow‐up period | Higher‐ vs lower‐dose prednisolone | Not estimable | 98 (1 RCT) | ⊕⊝⊝⊝ Very lowa,b,c | Only one 3‐arm study (Langton Hewer 1998) contributed events to this analysis. Two lower‐dose arms pooled for this outcome. OR 1.55 (0.24 to 9.78) favouring lower dose | |
| Not pooled | Not pooled | |||||
| Longer vs shorter course prednisolone | OR 0.33 (0.01 to 8.28) | 201 (1 RCT) | ⊕⊕⊝⊝ Lowc | |||
| 10 per 1000 | 3 per 1000 (0 to 76) | |||||
| Longer vs shorter course dexamethasone | OR 2.22 (0.19 to 25.27) | 100 (1 RCT) | ⊕⊝⊝⊝ Very lowc,d | |||
| 19 per 1000 | 42 per 1000 (4 to 331) | |||||
|
Asthma symptoms Symptom free by 7 days |
Longer vs shorter course prednisolone | OR 1.22 (0.67 to 2.19) | 201 (1 RCT) | ⊕⊕⊕⊝ Moderatee | One other study (Langton Hewer 1998) randomising 98 children to high‐ vs medium‐ vs low‐dose prednisolone reported clinical asthma score at discharge. Small differences in scores were reported with uncertain clinical importance and no consistent dose‐response effect | |
| 307 per 1000 | 351 per 1000 (229 to 492) | |||||
| Serious adverse events | Longer vs shorter course prednisolone | Not estimable | 201 (1 study) | No events occurred in either trial arm | ||
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
|
New exacerbation during follow‐up period Oral corticosteroids prescribed |
Higher‐ vs lower‐dose prednisolone | OR 1.38 (0.25 to 7.47) | 231 (2 RCTs) | ⊕⊕⊝⊝ Lowf | ||
| 17 per 1000 | 24 per 1000 (4 to 116) | |||||
| Longer vs shorter course prednisolone | OR 0.61 (0.19 to 1.94) | 201 (1 RCT) | ⊕⊕⊕⊝ Moderatee | |||
| 79 per 1000 | 50 per 1000 (16 to 143) | |||||
| Longer vs shorter course dexamethasone | OR 0.24 (0.05 to 1.19) | 100 (1 RCT) | ⊕⊕⊝⊝ Lowd,g | |||
| 154 per 1000 | 42 per 1000 (9 to 178) | |||||
|
New exacerbation during follow‐up period Unscheduled visit to healthcare provider |
Longer vs shorter course dexamethasone | OR 2.17 (0.67 to 7.01) | 100 (1 RCT) | ⊕⊝⊝⊝ Very lowc,d | ||
| 96 per 1000 | 188 per 1000 (67 to 427) | |||||
| Lung function tests FEV1% predicted at discharge | High vs medium vs low dose | ‐ | 34 (1 study) | This outcome includes only 1 small study (Langton Hewer 1998) in which a subset of participants were able to perform PFTs. Reported between‐group differences were small and of uncertain clinical importance with no consistent dose‐response effect. | ||
| ‐ | ‐ | |||||
| All adverse events | Longer vs short course prednisolone | OR 0.67 (0.11 to 4.08) | 201 (1 RCT) | ⊕⊕⊕⊝ Moderatee | ||
| 30 per 1000 | 20 per 1000 (3 to 111) | |||||
| *Risk in the intervention group (and its 95% confidence interval) is based on 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 1 second; OR: Odds ratio; PFTs: pulmonary function tests; RCT: randomised controlled trial; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to the estimate of effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
aOnly 1 study contributed events to this outcome and was assessed to be at high risk of attrition bias because of unbalanced drop‐out from intervention arms. Downgraded once for risk of bias
bThe study contributing events had 3 different dose arms, 1 of which is outside the current dosing guidelines. Two other studies reported no events, but intervention involved much higher doses of prednisolone. Downgraded once for indirectness
cOnly 1 study contributed to this analysis. Imprecise estimate with confidence intervals including possibility of important harms or benefits. Downgraded twice for imprecision
dOnly contributing study considered at high risk of bias in multiple domains. Downgraded once for risk of bias
eOnly 1 study contributed to this outcome, resulting in imprecise estimate and confidence intervals including the possibility of important harms or benefits. Downgraded once for imprecision
fOnly 2 studies contributed to this outcome with few events, resulting in imprecise estimate and wide confidence intervals including the possibility of important harms or benefits. Downgraded twice for imprecision
gOnly 1 study contributed to this outcome, resulting in imprecise estimate, which does not exclude the possibility of no difference. Downgraded once for imprecision