CQ7 Are increased doses of inhaled corticosteroids useful for acute exacerbation of bronchial asthma in children?

Abstract

 A systematic review (SR) was conducted to determine whether increased inhaled corticosteroids (ICS) dosages are useful for acute exacerbation of bronchial asthma in children. Randomized controlled trials (RCTs) were conducted to compare increased and stable daily dosages of ICS for asthma exacerbation in children. RCTs in children were selected from a previously published SR of adults and children. Databases (MEDLINE, Embase, and CENTRAL) were searched for RCTs published until March 2016. RCTs reported in Japanese were searched from a database of the Japan Medical Abstracts Society. One RCT was selected from a previously published SR in children and adults, while a second RCT was selected from an additional search. Both trials used beclomethasone (BDP) as the ICS. One study was a single-center, crossover study conducted in New Zealand, while the other was a multicenter, parallel-group study in the United States. None of the RCTs reported in Japanese were included in this study. The increased dosages of ICS did not reduce the risk of asthma exacerbations that required rescue systemic corticosteroids. Only RCTs that used BUD were found. Therefore, till date, there is limited evidence to support the recommendation of increasing the ICS dosage for asthma exacerbation in children.