NEBULIZED CORTICOSTEROIDS FOR ACUTE ASTHMATIC ATTACKS: A SYSTEMATIC REVIEW OF RANDOMIZED CONTROL TRIALS

Abstract

Saleh Farhan M. Alanazi*, Abdulkarim Ahmed M Alshammari, Rayan Ahmed Alanazi, Turki Hani S Alhazmi, Saud Ghadeer M Alanazi, Kholoud Obeid H Al Bathaly, Ahmed Rahil S Alanazi and Fahad Wadi S Alanazi

Objectives: To evaluate the effectiveness and safety of nebulized corticosteroids in the management of acute asthmatic attacks.

Methods: A thorough search across four databases identified 513 relevant publications. After removing duplicates using Rayyan QCRI and screening for relevance, the search yielded 226 publications, of which 37 fulltext articles were reviewed, and 5 met the eligibility criteria for evidence synthesis.

Results: We included 5 studies with a total of 361 patients (176 in the case group and 185 in the control group) and less than half of them were females 163 (45.2%). Nebulized corticosteroids, more specifically budesonide, are one of the promising treatments in acute asthma exacerbation, especially in children, because of its equal efficacy compared to systemic steroids but with fewer adverse effects. Corticosteroids may improve outcomes when given along with other treatments in adults, but as an intervention in isolation, the outcome is still uncertain. Much larger and standardized studies are required to evaluate the complete potential of nebulized corticosteroids in both children and adults.

Conclusion: Nebulized corticosteroids, more specifically budesonide, are a promising treatment option for acute asthma exacerbation and, in particular, in children because of its equal efficacy as compared to systemic steroids with less adverse effects. Corticosteroids may enhance outcomes when used in combination with other interventions in adults; as an isolated intervention, however, the outcome remains uncertain. Further largescale and standardized studies are necessary to establish the full potential of nebulized corticosteroids both in pediatric and adult populations.