Asthma in adults

INTRODUCTION: About 10% of adults have suffered an attack of asthma, and up to 5% of these have severe disease that responds poorly to treatment. Patients with severe disease have an increased risk of death, but patients with mild to moderate disease are also at risk of exacerbations. Most guidelines about the management of asthma follow stepwise protocols. This review does not endorse or follow any particular protocol, but presents the evidence about specific interventions.

METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for chronic, and for acute asthma? We searched: Medline, Embase, The Cochrane Library and other important databases up to October 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

RESULTS: We found 121 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: for acute asthma: beta(2) agonists (plus Ipratropium bromide, nebulisers, pressured metered-dose inhalers, short-acting continuous nebulised, short-acting intermittent nebulised, short-acting intravenous), corticosteroids (inhaled), corticosteroids (single oral, combined inhaled, short courses), education about acute asthma, generalist care, helium-oxygen mixture, magnesium sulphate (intravenous, adding isotonic nebulised magnesium to inhaled beta(2) agonists), mechanical ventilation, oxygen supplementation (controlled 28% oxygen, controlled 100% oxygen), specialist care. For chronic asthma: beta(2) agonists (adding long-acting inhaled when poorly controlled by inhaled corticosteroids, or short-acting inhaled as needed for symptom relief), inhaled corticosteroids (low dose, increasing dose), leukotriene antagonists (with or without inhaled corticosteroids), theophylline (when poorly controlled by inhaled corticosteroids).