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Asthma

Date Last Search Run: Feb 01, 2022
Table last updated: Aug 01, 2022
Data last added: Jul 16, 2022

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)  
2 (fair evidence exists)  
3 (weak evidence exists)  


Interventions

Anticholinergic
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Percent of predicted FEV1 Process In-Patient Bryant DH. Nebulized ipratropium bromide in the treatment of acute asthma. Chest 1985; 88:24-9. Medline
I Supportive (Green) Percent of predicted FEV1 Process ED-MD Bryant DH., Rogers P. Effects of ipratropium bromide nebulizer solution with and without preservatives in the treatment of acute and stable asthma. Chest 1992; 102:742-7. Medline
I Supportive (Green) FEV1 Process ED-MD FitzGerald JM., Grunfeld A., Pare PD., et al. The clinical efficacy of combination nebulized anticholinergic and adrenergic bronchodilators vs nebulized adrenergic bronchodilator alone in acute asthma. Chest 1997; 111(2):311-5. Medline
I Supportive (Green) Mean peak flow time Patient ED-MD Higgins RM., Stradling JR., Lane DJ. Should ipratropium bromide be added to beta-agonists in the treatment of acute severe asthma? Chest 1988; 94:718-22. Medline
I Supportive (Green) Improved FEV Patient ED-MD Lanes SF., Garrett JE., Wentworth CE., et al: The effect of adding ipratropium bromide to salbutamol in the treatment of acute asthma. Chest 1998; 114(2):365-372. Medline
I Supportive (Green) Peak expiratory flow rate Patient ED-MD Lin RY., Pesola GR., Bakalchuk L., et al. Superiority of ipratropium plus albuterol over albuterol alone in the emergency department management of adult asthma: A randomized clinical trial. Ann Emerg Med 1998; 31(2):208-13. Medline
I Supportive (Green) Resolution of symptoms Patient ED-MD Louw SJ., Goldin JG., Isaacs S. Relative efficacy of ipratropium bromide and fenoterol in acute severe asthma. S Afr Med J 1990; 77:24-26. Medline
I Supportive (Green) Peak flow rateĀ  Patient ED-MD O'Driscoll BR., Taylor RJ., Horsley MG., et al. Nebulized salbutamol with and without ipratropium bromide in acute airflow obstruction. Lancet 1989; 1:1418-20. Medline
I Supportive (Green) Forced expiratory volume Patient ED-MD Rebuck AS., Chapman KR., Abboud R., et al. Nebulized anticholinergic and sympathomimetic treatment of asthma and chronic obstructive airway disease in the emergency room. AM J Med 1987; 82:59-64. Medline
I Supportive (Green) Pulmonary function Patient ED-MD Rodrigo GJ., Rodrigo C. First-line therapy for adult patients with acute asthma receiving a multiple-dose protocol of ipratropium bromide plus albuterol in the emergency department. Am J Respir Crit Care Med 2000; 161(6):1862-8. Medline
I Supportive (Green) Change in peak expiratory flow rate and forced expiratory volume in one second Patient ED-MD Stoodley RG., Aaron SD., Dales RE. The role of ipratropium bromide in the emergency management of acute asthma exacerbation: a meta-analysis of randomized clinical trials. Ann Emerg Med 1999; 34(1):8-18. Medline
I Neutral (Yellow) FEV1 Process ED-MD Cydulka RK., Emerman CL., Muni A. Levalbuterol versuss levalbuterol plus ipratropium in the treatment of severe acute asthma. J Asthma 2010; 47(10):1094-100. Medline
I Neutral (Yellow) Functional Nebulized ipratropium in the treatment of acute asthma Patient ED-MD Summers QA., Tarala RA. Nebulized ipratropium in the treatment of acute asthma. Chest 1990; 97:425-429. Medline
II Supportive (Green) FEV1 Patient ED-MD Karpel JP., Appel D., Breidbart D., Fusco MJ. A comparison of atropine sulfate and metaproterenol sulfate in the emergency treatment of asthma. Am Rev Respir Dis 1986; 133(5):727-9. Medline
II Supportive (Green) Efficacy Patient ED-MD Leahy BC., Gomm SA., Allen SC. Comparison of nebulized salbutamol with nebulized ipratropium bromide in acute asthma. Br J Dis Chest 1983; 77:159-163. Medline
III Supportive (Green) Functional WH et al: Ipratropium bromide in acute asthma Patient ED-MD Ward MJ., Fentem PH., Smith WH., et al. Ipratropium bromide in acute asthma. BMJ 1981; 282:598-600. Medline

Beta Agonist-MDI
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) FEV1 Patient ED-MD Idris AH., McDermott MF., Raucci JC., Morrabel A., McGorray S., Hendeles L. Emergency department treatment of severe asthma. Metered-dose inhaler plus holding chamber is equivalent in effectiveness to nebulizer. Chest 1993; 103(3):665-72. Medline
I Supportive (Green) PEFR and symptoms scores Patient ED-MD Lee-Wong M., Chou V., Ogawa Y. Formoterol fumarate inhalation powder vs albuterol nebulizer for the treatment of asthma in the acute care setting. Ann Allergy Asthma Immunol 2008; 100(2):146-152. Medline
I Supportive (Green) FEV1 Patient ED-MD Rodrigo C., Rodrigo G. Salbutamol treatment of acute severe asthma in the ED: MDI versus hand-held nebulizer. Am J Emerg Med 1998; 16(7):637-42. Medline
I Supportive (Green) Spirometric measures Patient ED-MD Rodrigo GJ., Neffen H., Colodenco FD., Castro-Rodriguez JA. Formoterol for acute asthma in the emergency department: a systematic review with meta-analysis. Ann Allergy Asthma Immunol 2010; 104(3):247-52. Medline
I Supportive (Green) Pulmonary function Patient ED-MD Rodrigo GJ., Rodrigo C. First-line therapy for adult patients with acute asthma receiving a multiple-dose protocol of ipratropium bromide plus albuterol in the emergency department. Am J Respir Crit Care Med 2000; 161(6):1862-8. Medline
II Supportive (Green) PEFR, Respiratory Rate Process PH-Paramedic Campbell IA., Colman SB., Mao JH., et al. An open, prospective comparison of B2 agonists given via nebuliser, nebuhaler, or pressurised inhaler by ambulance crew as emergency treatment. Thorax 1995; 50:79-80. Medline
II Supportive (Green) Hospitalization rate Process ED-MD Mitselou N., Hedlin G., Hederos CA. Spacers versus nebulizers in treatment of acute asthma - a prospective randomized study in preschool children. The Journal of asthma 2016; 53(10):1059-62. Medline
III Supportive (Green) Pain level Patient ED-MD Dhuper S., Chandra A., Ahmed A., et al. Efficacy and cost comparisons of bronchodilatator administration between metered dose inhalers with disposable spacers and nebulizers for acute asthma treatment. J Emerg Med 2011; 40(3):247-55. Medline

Beta Agonist-Nebulized
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) FEV1 Process ED-MD Emerman CL., Cydulka RK., McFadden R. Comparison of 2.5 vs 7.5mg of inhaled albuterol in the treatment of acute asthma. Chest 1999; 115:92-6. Medline
I Supportive (Green) FEV1 Patient ED-MD Idris AH., McDermott MF., Raucci JC., Morrabel A., McGorray S., Hendeles L. Emergency department treatment of severe asthma. Metered-dose inhaler plus holding chamber is equivalent in effectiveness to nebulizer. Chest 1993; 103(3):665-72. Medline
I Supportive (Green) PEFR and symptoms scores Patient ED-MD Lee-Wong M., Chou V., Ogawa Y. Formoterol fumarate inhalation powder vs albuterol nebulizer for the treatment of asthma in the acute care setting. Ann Allergy Asthma Immunol 2008; 100(2):146-152. Medline
I Supportive (Green) FEV1 Patient ED-MD Rodrigo C., Rodrigo G. Salbutamol treatment of acute severe asthma in the ED: MDI versus hand-held nebulizer. Am J Emerg Med 1998; 16(7):637-42. Medline
I Supportive (Green) Spirometric measures Patient ED-MD Rodrigo GJ., Neffen H., Colodenco FD., Castro-Rodriguez JA. Formoterol for acute asthma in the emergency department: a systematic review with meta-analysis. Ann Allergy Asthma Immunol 2010; 104(3):247-52. Medline
I Supportive (Green) Pulmonary function Patient ED-MD Rodrigo GJ., Rodrigo C. First-line therapy for adult patients with acute asthma receiving a multiple-dose protocol of ipratropium bromide plus albuterol in the emergency department. Am J Respir Crit Care Med 2000; 161(6):1862-8. Medline
I Supportive (Green) FEV1 Patient ED-MD Rossing TH., Fanta CH., Goldstein DH., et al. Emergency therapy of asthma: Comparison of the acute effects of parenteral and inhaled sympathomimetics and infused aminophylline. Am Rev Respir Dis 1980; 122:365-71. Medline
I Supportive (Green) Paramedic Score, PEFR Process PH-Paramedic Zehner WJ., Scott JM., Iannolo PM., et al. Terbutaline vs albuterol for out-of-hospital respiratory distress: Randomized double-blind trial. Acad Emerg Med 1995; 2(8):686-691. Medline
I Neutral (Yellow) Difference in median asthma score at 2 hours Patient ED-MD Upham BD., Mollen CJ., Scarfone RJ., Seiden J., Chew A., Zorc JJ. Nebulized budesonide added to standard pediatric emergency department treatment of acute asthma: a randomized, double-blind trial. Acad Emerg Med 2011; 18(7):665-673. Medline
II Supportive (Green) PEFR, Respiratory Rate Process PH-Paramedic Campbell IA., Colman SB., Mao JH., et al. An open, prospective comparison of B2 agonists given via nebuliser, nebuhaler, or pressurised inhaler by ambulance crew as emergency treatment. Thorax 1995; 50:79-80. Medline
II Supportive (Green) Hospitalization rate Process ED-MD Mitselou N., Hedlin G., Hederos CA. Spacers versus nebulizers in treatment of acute asthma - a prospective randomized study in preschool children. The Journal of asthma 2016; 53(10):1059-62. Medline
II Supportive (Green) PEFR Patient PH-Paramedic Richmond N., Silverman R., Kusick M., et al. Out-of-Hospital Administration of Albuterol for Asthma by Basic Life Support Providers. Acad Emerg Med 2005; 12(5):396-403. Medline
II Supportive (Green) Peak expiratory flow rate Patient ED-MD Rudnitsky GS., Eberlein RS., Schoffstall JM., Mazur JE., Spivey WH. Comparison of intermittent and continuously nebulized albuterol for treatment of asthma in an urban emergency department. Ann Emerg Med 1993; 22(12):1842-6. Medline
II Supportive (Green) Mortality Patient PH-Paramedic Stiell IG., et al. Advanced Life Support for Out-of-Hospital Respiratory Distress. NEJM 2007; 356:2156-64. Medline
II Supportive (Green) Length of ED stay Patient PH-Paramedic Weiss SJ., Anand P., Ernst AA., Orgeron D., May WL. Effect of out-of-hospital albuterol inhalation treatments on patient comfort and morbidity. Ann Emerg Med 1994; 24(5):873-878. Medline
III Supportive (Green) Improved symptoms (Score 0-3) Patient ED-MD Dhuper S., Chandra A., Ahmed A., et al. Efficacy and cost comparisons of bronchodilatator administration between metered dose inhalers with disposable spacers and nebulizers for acute asthma treatment. J Emerg Med 2011; 40(3):247-55. Medline
III Supportive (Green) Peak flow Process PH-Paramedic Fergusson RJ., Stewart CM., Wathen CG., et al. Effectiveness of nebulised salbutamol administered in ambulances to patients with severe acute asthma. Thorax 1995; 50:80-2. Medline
III Supportive (Green) Clinical improvement Patient PH-Paramedic Markenson D., Foltin G., Tunik M., Cooper A., Treiber M., Caravaglia K. Albuterol Sulfate Administration by EMT-Basics: Results of a Demonstration Project. PEC 2004; 8(1):34-40. Medline
III Supportive (Green) Respiratory parameters Patient PH-Paramedic Rodenberg H. Effect of levalbuterol on prehospital patient parameters. Am J Emerg Med 2002; 20(5):481-3. Medline

Beta Agonist-Parenteral
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Hospital Admission Rate Process ED-MD Rowe BH., Spooner C., Ducharme FM., Bretzlaff JA., Bota GW. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev 2001; 1(1):CD002178. Medline
II Supportive (Green) Peak expiratory flow Patient ED-MD Spiteri MA., Millar AB., Pavia D., et al: Subcutaneous adrenaline versus terbutaline in the treatment of acute severe asthma. Thorax 1988; 43:19-23. Medline

Epinephrine- SQ
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Peak expiratory flow Patient ED-MD Spiteri MA., Millar AB., Pavia D., et al: Subcutaneous adrenaline versus terbutaline in the treatment of acute severe asthma. Thorax 1988; 43:19-23. Medline

Epinephrine-IM
Level Direction Primary Outcome Patient/Process Setting Reference

Epinephrine-IV
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Adverse events Patient ED-Paramedic & MD Putland M, Kerr D, Kelly A. Adverse events associated with the use of intravenous epinephrine in emergency department patients presenting with severe asthma. Ann Emerg Med. 2006;47(6):559-63. Medline
III Neutral (Yellow) Adverse effects Patient ED-MD Smith D., et al. IV Epinephrine in life-threatening asthma. Ann Emerg Med 2003; 41:706-11. Medline

Epinephrine-Nebulized
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Diagnostic performance Process ED-MD Abroug F., et al. A controlled trial of nebulized salbutamol and adrenaline in acute severe asthma. Intensive Care Med 1995; 21:18-23. Medline

High flow nasal canula
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Describe use in the ED setting-Vitals Patient Hughes J., Doolabh A. Heated, humidified, high-flow nasal oxygen usage in the adult Emergency Department. Australasian emergency nursing journal : AENJ 2016; 19(4):173-178. Medline
III Neutral (Yellow) Need for mechanical ventilation in the ED Patient Jones PG., Kamona S., Doran O., Sawtell F., Wilsher M. Randomized Controlled Trial of Humidified High-Flow Nasal Oxygen for Acute Respiratory Distress in the Emergency Department: The HOT-ER Study. Respir Care 2016; 61(3):291-9. Medline

Humidified oxygen
Level Direction Primary Outcome Patient/Process Setting Reference
III Neutral (Yellow) Need for mechanical ventilation in the ED Patient Jones PG., Kamona S., Doran O., Sawtell F., Wilsher M. Randomized Controlled Trial of Humidified High-Flow Nasal Oxygen for Acute Respiratory Distress in the Emergency Department: The HOT-ER Study. Respir Care 2016; 61(3):291-9. Medline

Hypertonic Saline-Nebulized
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) FEV1 Patient ED-MD Forouzan A., Masoumi K., Delirrooyfard A., Asgari Darian A., Mokhtar Gandomani L. Effect of Nebulized 3% Hypertonic Saline with Salbutamol on Management of Acute Asthma in Outpatient Adults: A Double-blind, Randomized Clinical Trial in Emergency Department. Iranian journal of allergy, asthma, and immunology 2017; 16(5):370-7. Medline

Intubation
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Mortality Patient PH-Paramedic Stiell IG., et al. Advanced Life Support for Out-of-Hospital Respiratory Distress. NEJM 2007; 356:2156-64. Medline

Magnesium Sulfate-IV
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Improvement in spirometric airway function Patient ED-MD Alter H., Koepsell T., Hilty W. Intravenous magnesium as an adjuvant in acute bronchospasm: A meta-analysis. Ann Emerg Med 2000; 36:191-7. Medline
I Supportive (Green) Safety Patient ED-MD Conway J, Friedman B, Zehtabchi S. Intravenous Magnesium Sulfate for Acute Asthma Exacerbation in Adults. Acad Emerg Med 2020; 27(10):1061-3. Medline
I Supportive (Green) Hospital admission Patient ED-MD Kew KM., Kirtchuk L., Michell CI. Intravenous magnesium sulfate for treating adults with acute asthma in the emergency department. Cochrane Database Syst Rev 2014; 5. Medline
I Supportive (Green) Admission to hospital Process ED-MD Rowe B., Bretzlaff J., Bourdon C., et al. Intravenous magnesium sulfate treatment for acute asthma in the emergency department: A systematic review of the literature. Ann Emerg Med 2000; 36:181-90. Medline
I Supportive (Green) Admission to hospital Process ED-MD Rowe B., Bretzlaff J., Bourdon C., et al. Intravenous magnesium sulfate treatment for acute asthma in the emergency department: A systematic review of the literature. Ann Emerg Med 2000; 36:181-90. Medline
I Supportive (Green) Mean FEV Patient ED-MD Silverman R., et al. IV Magnesium Sulfate in the Treatment of Acute Severe Asthma; A multicenter Randomized Controlled Trial. CHEST 2002; 122(2):489-497. Medline
I Supportive (Green) PEFR Patient ED-MD Skobeloff EM., Spivey WH., McNamara RM., Greenspon L. Intravenous magnesium sulfate for the treatment of acute asthma in the emergency department. JAMA 1989; 262(9):1210-1213. Medline
I Neutral (Yellow) Peak Expiratory Flow Rate Patient ED-MD Porter RS., Nester, Braitman LE., Geary U., Dalsey WC. Intravenous magnesium is ineffective in adult asthma, a randomized trial. Eur J Emerg Med 2001; 8(1):9-15. Medline
I Neutral (Yellow) Pulmonary function Patient ED-MD Rodrigo G., Rodrigo C., Burschtin O. Efficacy of magnesium sulfate in acute adult asthma: A meta-analysis of randomized trials. Am J Emerg Med 2000; 18:216-21. Medline
III Supportive (Green) Need for intubation Patient ED-MD Schiermeyer RP., Finkelstein JA. Rapid infusion of magnesium sulphate obviates need for intubation in status asthmaticus. Am J Emerg Med 1994; 12(2):164-6. Medline
III Neutral (Yellow) Hospital admission Process ED-MD Green SM., Rothrock SG. Intravenous magnesium for acute asthma: failure to decrease emergency treatment duration or need for hospitalization. Ann Emerg Med 1992; 21(3):260-5. medline

Magnesium Sulfate-nebulized
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Improvement in PEFR Patient Hossein S., Pegah A., Davood F., Said A., Babak M., Mani M., et al. The effect of nebulized magnesium sulfate in the treatment of moderate to severe asthma attacks: a randomized clinical trial. Am J Emerg Med 2016; 34(5):883-886. Medline
I Neutral (Yellow) Pulmonary function Patient Ling X., Wu Y., Kong J., et al. Lack of efficacy of nebulized magnesium sulfate in treating adult asthma: A meta-analysis of randomized controlled trials. Pulmonary Pharmacology & Therapeutics 2016; 41(40):e47. Medline
I Neutral (Yellow) Pulmonary function Patient ED-MD Rodrigo G., Rodrigo C., Burschtin O. Efficacy of magnesium sulfate in acute adult asthma: A meta-analysis of randomized trials. Am J Emerg Med 2000; 18:216-21. Medline
II Supportive (Green) FEV1 Process Gallegos-Solorzano MC., Perez-Padilla R., Hernandez-Zenteno RJ. Usefulness of inhaled magnesium sulfate in the co adjuvant management of severe asthma crisis in an emergency department. Pulm Pharmacol Ther 2010; 23(5):432-7. Medline
III Neutral (Yellow) Admission to hospital Process Goodacre S., Cohen J., Bradburn M., et al. The 3Mg trial: A randomised controlled trial of intravenous or nebulised magnesium sulphate versus placebo in adults with acute severe asthma. Health Technol Assess 2014; 18(22):1-168. Medline

NiPPV
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Reduction in dyspnea Patient PH-Paramedic Finn JC, Brink D, Mckenzie N, Garcia A, Tohira H, Perkins GD, Arendts G, Fatovich DM, Hendrie D, McQuillan B, Summers Q, Celenza A, Mukherjee A, Smedley B, Pereira G, Ball S, Williams T, Bailey P. Prehospital continuous positive airway pressure (CPAP) for acute respiratory distress: a randomised controlled trial. Emerg Med J. 2021 Mar 26:emermed-2020-210256. doi: 10.1136/emermed-2020-210256. Epub ahead of print. PMID: 33771819. Medline
I Supportive (Green) Need for tracheal intubation Patient PH-Paramedic Thompson J., Petrie DA., Ackroyd-Stolarz S., Bardua DJ. Out-of-hospital continuous positive pressure ventilation vs usual care in acute respiratory failure: a RCT. Ann Emerg Med 2008; 52(3):232-41. Medline
II Supportive (Green) Feasibility study on the use of pre-hospital CPAP Process PH-Paramedic Fuller GW, Goodacre S, Keating S, Perkins G, Ward M, Rosser A, et al. The ACUTE (Ambulance CPAP: Use, Treatment effect and economics) feasibility study: A pilot randomized controlled trial of prehospital CPAP for acute respiratory failure. Pilot and feasibility studies 2018; 4:86. Medline
II Supportive (Green) Feasibility Process PH-Paramedic Fuller GW, Goodacre S, Keating S, Perkins G, Ward M, Rosser A, et al. The ACUTE (Ambulance CPAP: Use, Treatment effect and economics) feasibility study: A pilot randomized controlled trial of prehospital CPAP for acute respiratory failure. Pilot and feasibility studies 2018; 4:86. Medline
II Supportive (Green) SpO2, RR Patient Sahu N, Matthews P, Groner K, Papas MA, Megargel R. Observational Study on Safety of Prehospital BLS CPAP in Dyspnea. Prehosp Disaster Med 2017; 32(6):610-4. Medline
II Neutral (Yellow) Intubation rate Process PH-Paramedic Cheskes S., Turner L., Thomson S., Aljerian N. The Impact of Prehospital Continuous Positive Airway Pressure on the Rate of Intubation and Mortality from Acute Out-of-hospital Respiratory Emergencies. Prehosp Emerg Care 2013; 17(4):435-41. Medline
III Supportive (Green) Respiratory Rate and SpO2 Patient PH-Paramedic Bledsoe BE., Anderson E., Hodnick R., Johnson L., Johnson S., Dievendorf E. Low-fractional oxygen concentration continuous positive airway pressure is effective in the prehospital setting. Prehosp Emerg Care 2012; 16(2):217-21. Medline
III Supportive (Green) Mortality Patient ED-MD Ram FSF., Wellington SR., Rowe B., Wedzicha A. Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe exacerbations of asthma. Cochrane Database of Systematic Reviews 2005; (3). Medline

Oxygen
Level Direction Primary Outcome Patient/Process Setting Reference
III Neutral (Yellow) PaO2 Process ED-MD Ford DJ., Rothwell RP. Safe oxygen in acute asthma: Prospective trial using 35% ventimask prior to admission. Resp Med 1989; 83:189-94. Medline

Oxymetry Monitoring
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Detection of hypoxemia Patient PH-Paramedic Bota GW., Rowe BH. Continuous monitoring of oxygen saturation in prehospital patients with severe illness: the problem of unrecognized hypoxemia. J Emerg Med 1995; 13:305-11. Medline

Steroids-Inhaled
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Hospital admission Process ED-MD Edmonds ML., Camargo CA. Jr, Pollack CV. Jr, Rowe BH. Early use of inhaled corticosteroids in the emergency department treatment of acute asthma. Cochrane Database Syst Rev 2003; 3(3):CD002308. Medline
I Supportive (Green) Hospital admission Process ED-MD Edmonds ML., Camargo CA. Jr, Pollack CV. Jr, Rowe BH. The effectiveness of inhaled corticosteroids in the emergency department treatment of acute asthma: a meta-analysis. Ann Emerg Med 2002; 40(2):145-54. Medline
I Supportive (Green) Change in % predicted FEV1 Process ED-MD Guttman A., Afilalo M., Colacone A., Kreisman H., Dankoff J. The effects of combined intravenous and inhaled steroids (beclomethasone dipropionate) for the emergency treatment of acute asthma. The Asthma ED Study Group. Acad Emerg Med 1997; 4(2):100-6. Medline
I Supportive (Green) Pulmonary Function Patient ED-MD Rodrigo G., Rodrigo C. Corticosteroids in the emergency department therapy of acute adult asthma: an evidence-based evaluation. Chest 1999; 116(2):285-95. Medline
II Supportive (Green) Incidence of stent Thrombosis Patient ICU Starobin D., Bolotinsky L., Or J., Fink G., Shtoeger Z. Efficacy of nebulized fluticasone propionate in adult patients admitted to the emergency department due to bronchial asthma attack. Isr Med Assoc J 2008; 10(8-9):568-571. Medline
III Supportive (Green) FEV1 Patient ED-MD Afilalo M., Guttman A., Colacone A., Dankoff J., Tselios C., Stern E., et al. Efficacy of inhaled steroids (beclomethasone dipropionate) for treatment of mild to moderately severe asthma in the emergency department: a randomized clinical trial. Ann Emerg Med 1999; 33(3):304-9. Medline

Steroids-IV
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Peak expiratory flow rate Patient ED-MD Lin RY., Pesola GR., Bakalchuk L., Heyl GT., Dow AM., Tenenbaum C., et al. Rapid improvement of peak flow in asthmatic patients treated with parenteral methylprednisolone in the emergency department: A randomized controlled study. Ann Emerg Med 1999; 33(5):487-94. Medline
I Supportive (Green) Hospital Admission Rate Process ED-MD Rowe BH., Spooner C., Ducharme FM., Bretzlaff JA., Bota GW. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev 2001; 1(1):CD002178. Medline
I Neutral (Yellow) Peak expiratory flow rate Patient ED-MD Lin RY., Pesola GR., Westfal RE., et al. Early parenteral corticosteroid administration in acute asthma. Am J Emerg Med 1997; 15(7):621-625. Medline
I Neutral (Yellow) Efficacy Patient PH-Paramedic Rodrigo G., Rodrigo C. Corticosteroids in the emergency department therapy of acute adult asthma: an evidence-based evaluation. Chest 1999; 116(2):285-95. Medline
I Neutral (Yellow) Pulmonary function Patient ED-MD Rowe BH., Kell JL., Oxman AD. Effectiveness of steroid therapy in acute exacerbations of asthma: A meta-analysis. Am J Emerg Med 1992; 10:301-10. Medline
I Neutral (Yellow) Duration of ED treatment (hrs) Patient ED-MD Stein LM., Cole RP. Early administration of corticosteroids in emergency room treatment of acute asthma. Ann Intern Med 1990; 112(11):822-827. Medline
II Neutral (Yellow) Hospital admission and discharge rate Patient ED-MD Starobin D., Bolotinsky L., Or J., Fink G., Shtoeger Z. Efficacy of nebulized fluticasone propionate in adult patients admitted to the emergency department due to bronchial asthma attack. Isr Med Assoc J 2008; 10(8-9):568-571. Medline

Steroids-Oral
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Hospital admission Process ED-MD Edmonds ML., Camargo CA. Jr, Pollack CV. Jr, Rowe BH. The effectiveness of inhaled corticosteroids in the emergency department treatment of acute asthma: a meta-analysis. Ann Emerg Med 2002; 40(2):145-54. Medline
I Supportive (Green) Relapse to additional care Patient ED-MD Kirkland SW., Cross E., Campbell S., Villa-Roel C., Rowe BH. Intramuscular versus oral corticosteroids to reduce relapses following discharge from the emergency department for acute asthma. The Cochrane database of systematic reviews 2018; 6:CD012629 Medline
I Supportive (Green) Pulmonary function Patient ED-MD Rowe BH., Kell JL., Oxman AD. Effectiveness of steroid therapy in acute exacerbations of asthma: A meta-analysis. Am J Emerg Med 1992; 10:301-10. Medline
I Neutral (Yellow) Pulmonary Function Patient ED-MD Rodrigo G., Rodrigo C. Corticosteroids in the emergency department therapy of acute adult asthma: an evidence-based evaluation. Chest 1999; 116(2):285-95. Medline

Steroids-Parenteral
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Hospital admission Process ED-MD Edmonds ML., Camargo CA. Jr, Pollack CV. Jr, Rowe BH. The effectiveness of inhaled corticosteroids in the emergency department treatment of acute asthma: a meta-analysis. Ann Emerg Med 2002; 40(2):145-54. Medline
I Supportive (Green) Relapse to additional care Patient ED-MD Kirkland SW., Cross E., Campbell S., Villa-Roel C., Rowe BH. Intramuscular versus oral corticosteroids to reduce relapses following discharge from the emergency department for acute asthma. The Cochrane database of systematic reviews 2018; 6:CD012629 Medline
I Supportive (Green) Relapse Patient ED-MD Rowe BH., Kirkland SW., Vandermeer B., Campbell S., Newton A., Ducharme FM., et al. Prioritizing Systemic Corticosteroid Treatments to Mitigate Relapse in Adults With Acute Asthma: A Systematic Review and Network Meta-analysis. Academic emergency medicine 2017; 24(3):371-81. Medline
I Supportive (Green) Hospital Admission Rate Process ED-MD Rowe BH., Spooner C., Ducharme FM., Bretzlaff JA., Bota GW. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev 2001; 1(1):CD002178. Medline


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