Summary of the 8 included studies in the review.
| Reference | Holden et al. [27] | Kocak et al. [28] | Elkharwili et al. [29] | Li et al. [30] | Gileles-Hillel et al. [31] | Kim et al. [32] | Jartti et al. [16] | Jartti et al. [15] | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Year | 2017 | 2006 | 2020 | 2024 | 2021 | 2022 | 2006 | 2015 | ||||||||
| Country | UK | Turkey | Egypt | China | Israel | South Korea | Finland | Finland | ||||||||
| Total n | 85 | 40 | 60 | 202 | 234 | 82 | 78 | 74 | ||||||||
| Setting | ED | Ward/OPD | ED | Hospital | Paediatric ward | ED | ED/ward | |||||||||
| Study intervention/design | Observational (patients received OCS as per local protocol) | Observational [patients received PRED 1–2 mg/kg per day for 5 days (maximum, 40 mg/day)] | DBRCT [DEX (0.3 mg/kg) OR multiple doses (0.6 mg/kg) for 2 days or PRED 5-day course (1.5 mg/kg)] | Observational (aerosolizedhigh-dose glucocorticoids given in exacerbation) | Retrospective comparison of: DEX 0.3–0.6 mg/kg/day, 1–5 days or bethamethasone 0.2 mg/kg/day, 3–5 days | Observational (all patients received SCS as part of local protocol) | DBRCT (oral PRED 2 mg/kg per day in three divided doses for 3 days or placebo) | |||||||||
| Study objective | Investigate if there is a difference in BEO during the acute and stable phase of children with preschool wheeze | Evaluate the immune biomarkers and the effects of glucocorticoid treatment on acute asthma exacerbations compared to healthy children | Evaluate the effectiveness of different doses of DEX vs. PRED in managing asthma exacerbations in children | Investigate the role of 14-3-3β in acute asthma exacerbations and evaluate risk factors contributing to asthma exacerbation | Compare the effectiveness of betamethasone versus DEX in managing acute wheezing in preschool children requiring hospital admission | Evaluate the association of EDN with lung function and the prognosis of children hospitalised for severe asthma exacerbation | Evaluate the short- and long-term effects of PRED when given during the first acute and moderate-to-severe rhinovirus-induced wheezing episode in young children | |||||||||
| Acute exacerbation | Exacerbation (> 24 h) of doctor diagnosed wheeze | Acute asthma exacerbation (severity as per NAEPP) | Exacerbation defined according to National Institutes of Health, which requires use of SCS | Asthma exacerbation requiring a change in treatment medication, ED visit or SCS | Acute wheezing requiring hospitalisation | Severe asthma exacerbation | Hospitalised children with acute wheeze caused by respiratory virus. Exacerbation determined by respiratory symptoms score (RSS) | |||||||||
| Severity of exacerbations | Severity not reported | 16% mild64% mod20% severe | Baseline PRAM scores not reported | 61% mild-mod39% severe | 100% hospitalised due to O2 requirement or failure of response to treatment | 100% severe | Mean RSS = 6.2/12 (moderate) | 82% admitted | ||||||||
| Population asthma or wheeze history | At least 1 previous parent-reported wheeze | Asthma as per ATS criteria | Previous history of asthma exacerbation | Asthma diagnosed according to GINA guidelines | Not specified: 41% Previous diagnosis of asthma; 17% using ICS | Severe asthma exacerbation requiring admission and 3 days SCS | 1st or 2nd episode of wheezing | Absence of prior episodes of wheeze | ||||||||
| Subgroups of total population | Acuten = 68 | Controln = 17 | Acuten = 25 | Controln = 15 | DEXGroup I (0.3 mg/kg) n = 20Group 2 (0.6 mg/kg) n = 20 | PREDn = 20 | Acute exacerbationn = 101 | Stablen = 101 | Controln = 65 | Bethamethasonen = 145 | DEXn = 89 | Diagnosis of asthma including evidence of BDR or bronchial hyperresponsiveness in the last 1 y. | Rhinovirusn = 40 | RSVn = 38 | PREDn = 34 | Placebon = 40 |
| Age mean | N/A | N/A | 9.6 years | 8.8 years | G1 = 5.93 ± 2.37 yearsG2 = 6.52 ± 2.64 years | 6.15 ± 2.75 years | N/A | N/A | N/A | N/A | N/A | 11.2 ± 3.6 years | 1.38 ± 0.62 years | 0.86 ± 0.59 years | 13.2 ± 6.9 months | 12.2 ± 5.1 months |
| Age median | 31.2 m | 39.5 m | N/A | N/A | N/A | N/A | 6.8 years | 6.9 years | 7.2 years | 2.5 years | N/A | N/A | N/A | N/A | N/A | |
| Gender Male (%) | 62 | 82 | 52 | 53 | G1 = 40G2 = 50 | 55 | 63 | 60 | 60 | 59 | 67 | 70 | 63 | 47 | 79 | 75 |
| Atopy definition | Parental report of eczema or allergic rhinitis diagnosis | Elevated eosinophil count, IgE and positive RAST | N/A | Serum specific IgE concentration | Through personal history | Presence of a total serum IgE value > 100 IU/mL or sensitization to common allergens | Positive IgE against selected allergens | Positive IgE against selected allergens | ||||||||
| Atopy history (%) | 49 | 29 | 64 | N/A | N/A | N/A | 45 | 37 | N/A | 18 | 28 | 43 | 44 | 8 | 29 | 31 |
m: months in the age category. ATS: American Thoracic Society; BDR: bronchodilator response; BEO: blood eosinophils; DBRCT: double blind randomised controlled trial; DEX: dexamethasone; ED: emergency department; EDN: eosinophil-derived neurotoxin; GINA: Global Initiative for Asthma; ICS: inhaled corticosteroid; N/A: not available; NAEPP: National Asthma Education and Preventing Program; OCS: oral corticosteroid; OPD: Outpatient department; PRAM: pediatric respiratory assessment measure; PRED: prednisolone; RSV: respiratory syncytial virus; SCS: systemic corticosteroids.