Grade table 6

Question: Should oral corticosteroids versus placebo be used for preventing relapse following acute exacerbations of asthma in adults?

Settings: Emergency department

Bibliography: Rowe BH et al. (5)

Quality assessmentSummary of findingsImportance
No of patientsEffectsQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsOral corticosteroidsPlaceboRelative (95% CI)Absolute
Relapse rates – 7–10 day follow-up
4randomised trialsno serious limitationno serious inconsistencyserious1no serious imprecisionnone8/127 (6.3%)19/129 (14.7%)RR 0.44 (0.21 to 0.94)82 fewer per 1000 (from 9 fewer to 116 fewer)⊕⊕⊕○
MODERATE		IMPORTANT
Relapse rates – 21-day follow-up
1randomised trialsno serious limitationserious2serious1no serious imprecisionnone10/48 (20.8%)20/45 (44.4%)RR 0.47 (0.25 to 0.89)236 fewer per 1000 (from 49 fewer to 333 fewer)⊕⊕○○
LOW		IMPORTANT
Pulmonary function tests (PFTs) (better indicated by lower values)
2no methodology chosennone3031–MD 6.66 higher (3.5 lower to 16.83 higher)––
1

Studies carried out in the emergency department with prednisolone, methylprednisolone and dexamethasone. Tapered courses over eight days or so in adults and single study in children, but no relapses in either group.

2

Single study only.

From: Annex 4, Grade tables

Cover of Prevention and Control of Noncommunicable Diseases
Prevention and Control of Noncommunicable Diseases: Guidelines for Primary Health Care in Low Resource Settings.
Copyright © 2012, World Health Organization.

All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob).

Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press through the WHO web site (http://www.who.int/about/licensing/copyright_form/en/index.html).

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.