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![Refrences
• Schuh S , Reisman J , Alshehri M , Dupuis A , Corey M , Arseneault R , Alothman G ,
Tennis O and Canny G. A comparison of inhaled fluticasone and oral prednisone for
children with severe acute asthma .The New England journal of medicine, 2000,
343(10), 689.
• National Guideline Clearinghouse 2012 Oct 22. Systemic corticosteroids for acute
asthma in adults and adolescents. DynaMed [database on the Internet]. 2013 [cited
2013 Dec 27]. Available from:
http://web.ebscohost.com/dynamed/detail?sid=e5ed58d4-1dcb-4a1c-9314-
b0746cccae77%40sessionmgr113&vid=5&hid=120&bdata=JnNpdGU9ZHluYW1lZC1s
aXZlJnNjb3BlPXNpdGU%3d#db=dme&AN=361024 .
• Edmonds ML, Milan SJ, Brenner BE, Camargo Jr CA, Rowe BH. Inhaled steroids for
acute asthma following emergency department discharge. Cochrane Database of
Systematic Reviews 2012, Issue 12. Art. No.: CD002316.
DOI:10.1002/14651858.CD002316.pub2.
• Richard J Scarfone, Md, Faap. Acute asthma exacerbations in children: Outpatient
management. Uptodate [database on the Internet]. 2013 [cited 2013 Dec 27].
Available from: http://www.uptodate.com.search.sti.sci.eg:2048/contents/acute-
asthma-exacerbations-in-children-outpatient-
management?source=search_result&search=acute+asthma+exacerbation+children&s
electedTitle=2~150#H45 .
• Quon BS, FitzGerald JM, Lemiere C, et al. Increased versus stable doses of inhaled
corticosteroids for exacerbations of chronic asthma in adults and children. Cochrane
Database Syst Rev. 2010 ;( 10):CD007524.](https://image.slidesharecdn.com/hj7gwatqqfovyh4g3pao-140523011901-phpapp02/85/EBM-54-320.jpg)
![Refrences
• Bestpractice. Acute asthma exacerbation in children. BestPractice [database on the
Internet]. 2013 [cited 2013 Dec 27]. Available from: http://bestpractice.bmj.com/best-
practice/monograph/1098/treatment/evidence.html .
• Augusta Okpapi, Amanda J Friend, and Stephen W Turner. Asthma and other
recurrent wheezing disorders in children (acute). ClinicalEvidence [database on the
Internet]. 2010 [cited 2013 Dec 27]. Available from:
http://clinicalevidence.bmj.com/x/systematic-review/0300/key-points.html .
• Scottish Intercollegiate Guidelines Network (SIGN), British Thoracic Society. British
guideline on the management of asthma. A national clinical guideline. Edinburgh
(Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2011 May. 141
p. (SIGN publication; no. 101).
• Sveum R, Bergstrom J, Brottman G, Hanson M, Heiman M, Johns K, Malkiewicz J,
Manney S, Moyer L, Myers C, Myers N, O’Brien M, Rethwill M, Schaefer K, Uden D.
Diagnosis and management of asthma. Bloomington (MN): Institute for Clinical
Systems Improvement (ICSI); 2012 Jul. 86 p.
• This guideline updates a previous version: Michigan Quality Improvement Consortium.
Management of asthma in youth 12 years and older and adults. Southfield (MI):
Michigan Quality Improvement Consortium; 2010 Jul. 1 p.
• Deborah A. Humphrey, Do, Facp. Asthma (acute exacerbation).
EssentialEvidencePlus [database on the Internet]. 2011 [cited 2013 Dec 27]. Available
from: http://www.essentialevidenceplus.com/content/eee/662 .
• Cochrane Database Syst Rev 2012 Dec 12. Inhaled corticosteroids for acute asthma
in children. DynaMed [database on the Internet]. 2013 [cited 2013 Dec 27]. Available
from: http://web.ebscohost.com/dynamed/detail?sid=e5ed58d4-1dcb-4a1c-9314-
b0746cccae77%40sessionmgr113&vid=4&expand=NHLBIgeneral&hid=120&bdata=Jn
NpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU%3d#db=dme&AN=361098&anchor=
NHLBIgeneral .](https://image.slidesharecdn.com/hj7gwatqqfovyh4g3pao-140523011901-phpapp02/85/EBM-55-320.jpg)
![Refrences
• British Thoracic Society and Scottish Intercollegiate Guidelines Network (sign)
National Clinical Guideline on Management of Asthma. Systemic corticosteroids for
acute asthma in children. DynaMed [database on the Internet]. 2012 [cited 2013 Dec
27]. Available from: http://web.ebscohost.com/dynamed/detail?sid=e5ed58d4-1dcb-
4a1c-9314-b0746cccae77%40sessionmgr113&vid=4&expand=NHLBI-
Discharge&hid=120&bdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU%3d#
db=dme&AN=361064&anchor=Asthma-exacerbation-in-children-2-years-old .
• Obstet Gynecol 2013 Feb. Asthma exacerbation in adults and adolescents. DynaMed
[database on the Internet]. 2013 [cited 2013 Dec 27]. Available from:
http://web.ebscohost.com/dynamed/detail?vid=4&sid=e5ed58d4-1dcb-4a1c-9314-
b0746cccae77%40sessionmgr113&hid=120&bdata=JnNpdGU9ZHluYW1lZC1saXZlJ
nNjb3BlPXNpdGU%3d#db=dme&AN=114076 .
• Cochrane Database Syst Rev 2012 Dec 12. Inhaled corticosteroids for acute asthma
in adults and adolescents. DynaMed [database on the Internet]. 2013 [cited 2013 Dec
27]. Available from: http://web.ebscohost.com/dynamed/detail?vid=4&sid=e5ed58d4-
1dcb-4a1c-9314
b0746cccae77%40sessionmgr113&hid=120&bdata=JnNpdGU9ZHluYW1lZC1saXZlJ
nNjb3BlPXNpdGU%3d#db=dme&AN=361022 .
• DUNCAN KEELEY, MICHAEL MCKEAN. Asthma and Other Wheezing Disorders in
Children. Am Fam Physician. 2006 Dec 1; 74(11):1901-1905.
• Marcia L. Edmonds, Md, Msc; Carlos A. Camargo, Jr., Md, Drph, Fccp; Barry E.
Brenner, Md, Phd, Fccp; Brian H. Rowe, Md, Msc. Replacement of Oral
Corticosteroids With Inhaled Corticosteroids in the Treatment of Acute Asthma
Following Emergency Department Discharge*: A Meta-analysis. Chest. 2002;
121(6):1798-1805. doi:10.1378/chest.121.6.1798 [homepage on the Internet].[cited
2013 Dec 27]. Available from:
http://journal.publications.chestnet.org/article.aspx?articleid=1080705 .](https://image.slidesharecdn.com/hj7gwatqqfovyh4g3pao-140523011901-phpapp02/85/EBM-56-320.jpg)
Uploaded byRehab Rayan
EBM
The document discusses evidence and guidelines for treating a 12-year-old girl presenting to the emergency department with an acute asthma attack. It recommends initiating inhaled bronchodilators and oral corticosteroids as first-line treatment. For increased severity, systemic glucocorticoids should be added. After discharge, high-dose inhaled corticosteroids alone or with a short course of oral corticosteroids can effectively prevent recurrence while reducing need for hospitalization compared to other medications.
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- 1. Rehab Aly Rayan EBMFinal Assignment (64)
- 2. What is Inside…!!! Examine Clinical Question Evidence Summery Conclusion ---To the Patient … • Scenario • Background… more • PICO • Pre-appraised • Un-appraised
- 3. Evidence • PubMed • Trip-database •SUMSearch •Cochrane Library •Up-to-Date •Best-Practice •Clinical-Evidence •National Guideline Clearinghouse •Essential-Evidence-Plus •DynaMed Appraised Meta search Engine Un- appraised
- 4. Examine Scenario 12-y girl/ED 12-hr troublesomecough /wheezing /increasing breathlessness /unresponsive to inhaled albuterol troublesome asthma since age 18 months fluticasone/salmeterol via a pressurized metered-dose inhaler and large-volume spacer, and an albuterol inhaler, needed/ properly compliant with her preventive medication
- 5. More About theCase ... • Acute Asthma Attack Diagnosis • Acute Severe Asthma • Acute asthma Exacerbation • Status Asthmaticus Disease Synonyms • Disease Synonyms • Fluticasone • Child* Or pediatr* Or Audolescen* • Recurrence/Relapse Key words/Search Terms
- 6. The clinical question •In a 12-year-old girl presents to the emergency department with Acute Asthma Attack, Dose the use of the current Medication Regimen including Inhaled Fluticasone (375 µg/d) compared to other medications, will prevent attacks recurrence or relapse? • PICO Therapy/Prevention Patient 12-year-old girl with Acute Asthma Exacerbation Intervention Current treatment regimen including Inhaled Fluticasone (375µg/d) Comparison Other Medications Outcome Prevent Recurrence/Relapse of Asthma Attacks
- 8. Evidence • PubMed • Trip-database •SUMSearch• Cochrane Library •Up-to-Date •Best-Practice •Clinical-Evidence •National Guideline Clearinghouse •Essential-Evidence-Plus •DynaMed Appraised Meta search Engine Un- appraised
- 13. Evidence • PubMed • Trip-database •SUMSearch • Cochrane Library • Up-to-Date •Best-Practice •Clinical-Evidence •National Guideline Clearinghouse •Essential-Evidence-Plus •DynaMed Appraised Meta search Engine Un- appraised
- 16. Evidence • PubMed • Trip-database •SUMSearch • Cochrane Library • Up-to-Date • Best-Practice •Clinical-Evidence •National Guideline Clearinghouse •Essential-Evidence-Plus •DynaMed Appraised Meta search Engine Un- appraised
- 20. Evidence • PubMed • Trip-database •SUMSearch • Cochrane Library • Up-to-Date • Best-Practice • Clinical-Evidence •National Guideline Clearinghouse •Essential-Evidence-Plus •DynaMed Appraised Meta search Engine Un- appraised
- 24. Evidence • PubMed • Trip-database •SUMSearch • National Guideline Clearinghouse •Essential-Evidence-Plus •DynaMed Appraised Meta search Engine Un- appraised
- 29. Evidence • PubMed • Trip-database •SUMSearch • National Guideline Clearinghouse • Essential-Evidence- Plus •DynaMed Appraised Meta search Engine Un- appraised
- 31. Evidence • PubMed • Trip-database •SUMSearch • National Guideline Clearinghouse •Essential-Evidence-Plus • DynaMed Appraised Meta search Engine Un- appraised
- 35. Evidence • PubMed • Trip-database •SUMSearch •Cochrane Library •Up-to-Date •Best-Practice •Clinical-Evidence •National Guideline Clearinghouse •Essential-Evidence-Plus •DynaMed Appraised Meta search Engine Un- appraised
- 40. Evidence • PubMed • Trip-database •SUMSearch •Cochrane Library •Up-to-Date •Best-Practice •Clinical-Evidence •National Guideline Clearinghouse •Essential-Evidence-Plus •DynaMed Appraised Meta search Engine Un- appraised
- 44. Evidence • PubMed • Trip-database •SUMSearch •Cochrane Library •Up-to-Date •Best-Practice •Clinical-Evidence •National Guideline Clearinghouse •Essential-Evidence-Plus •DynaMed Appraised Meta search Engine Un- appraised
- 50. Summery • Inhaled bronchodilatorsand oral corticosteroids are the first-line treatment for acute asthma. (7) • Inhaled short-acting beta 2-agonists plus Systemic glucocorticoids added according to increased severity. (4) • Doubling dose of inhaled steroid not recommended for home management of exacerbations. While high-dose inhaled, steroid or oral steroids may be effective. (12) • A high-dose Inhaled Corticosteroids therapy alone may be of a similar effectiveness as oral corticosteroid therapy when used after Emergency Department discharge. (3, 7, 16, 17) • Systematic corticosteroids may be better than high-dose inhaled corticosteroids in reducing relapse and preventing hospitalization in severe attacks. (2, 5, 6, 11, 13-16) • Oral prednisone is more preferable over any other inhaled corticosteroid including fluticasone. (1)
- 53. To the Patient… •The patient can continue the usual treatment with an increased dose (800 µg /day) of Inhaled Corticosteroids after Emergency Department discharge along with a prescribed short course of oral corticosteroids (3-10 d). (2, 3, 8-10)
- 54. Refrences • Schuh S, Reisman J , Alshehri M , Dupuis A , Corey M , Arseneault R , Alothman G , Tennis O and Canny G. A comparison of inhaled fluticasone and oral prednisone for children with severe acute asthma .The New England journal of medicine, 2000, 343(10), 689. • National Guideline Clearinghouse 2012 Oct 22. Systemic corticosteroids for acute asthma in adults and adolescents. DynaMed [database on the Internet]. 2013 [cited 2013 Dec 27]. Available from: http://web.ebscohost.com/dynamed/detail?sid=e5ed58d4-1dcb-4a1c-9314- b0746cccae77%40sessionmgr113&vid=5&hid=120&bdata=JnNpdGU9ZHluYW1lZC1s aXZlJnNjb3BlPXNpdGU%3d#db=dme&AN=361024 . • Edmonds ML, Milan SJ, Brenner BE, Camargo Jr CA, Rowe BH. Inhaled steroids for acute asthma following emergency department discharge. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD002316. DOI:10.1002/14651858.CD002316.pub2. • Richard J Scarfone, Md, Faap. Acute asthma exacerbations in children: Outpatient management. Uptodate [database on the Internet]. 2013 [cited 2013 Dec 27]. Available from: http://www.uptodate.com.search.sti.sci.eg:2048/contents/acute- asthma-exacerbations-in-children-outpatient- management?source=search_result&search=acute+asthma+exacerbation+children&s electedTitle=2~150#H45 . • Quon BS, FitzGerald JM, Lemiere C, et al. Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children. Cochrane Database Syst Rev. 2010 ;( 10):CD007524.
- 55. Refrences • Bestpractice. Acuteasthma exacerbation in children. BestPractice [database on the Internet]. 2013 [cited 2013 Dec 27]. Available from: http://bestpractice.bmj.com/best- practice/monograph/1098/treatment/evidence.html . • Augusta Okpapi, Amanda J Friend, and Stephen W Turner. Asthma and other recurrent wheezing disorders in children (acute). ClinicalEvidence [database on the Internet]. 2010 [cited 2013 Dec 27]. Available from: http://clinicalevidence.bmj.com/x/systematic-review/0300/key-points.html . • Scottish Intercollegiate Guidelines Network (SIGN), British Thoracic Society. British guideline on the management of asthma. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2011 May. 141 p. (SIGN publication; no. 101). • Sveum R, Bergstrom J, Brottman G, Hanson M, Heiman M, Johns K, Malkiewicz J, Manney S, Moyer L, Myers C, Myers N, O’Brien M, Rethwill M, Schaefer K, Uden D. Diagnosis and management of asthma. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2012 Jul. 86 p. • This guideline updates a previous version: Michigan Quality Improvement Consortium. Management of asthma in youth 12 years and older and adults. Southfield (MI): Michigan Quality Improvement Consortium; 2010 Jul. 1 p. • Deborah A. Humphrey, Do, Facp. Asthma (acute exacerbation). EssentialEvidencePlus [database on the Internet]. 2011 [cited 2013 Dec 27]. Available from: http://www.essentialevidenceplus.com/content/eee/662 . • Cochrane Database Syst Rev 2012 Dec 12. Inhaled corticosteroids for acute asthma in children. DynaMed [database on the Internet]. 2013 [cited 2013 Dec 27]. Available from: http://web.ebscohost.com/dynamed/detail?sid=e5ed58d4-1dcb-4a1c-9314- b0746cccae77%40sessionmgr113&vid=4&expand=NHLBIgeneral&hid=120&bdata=Jn NpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU%3d#db=dme&AN=361098&anchor= NHLBIgeneral .
- 56. Refrences • British ThoracicSociety and Scottish Intercollegiate Guidelines Network (sign) National Clinical Guideline on Management of Asthma. Systemic corticosteroids for acute asthma in children. DynaMed [database on the Internet]. 2012 [cited 2013 Dec 27]. Available from: http://web.ebscohost.com/dynamed/detail?sid=e5ed58d4-1dcb- 4a1c-9314-b0746cccae77%40sessionmgr113&vid=4&expand=NHLBI- Discharge&hid=120&bdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU%3d# db=dme&AN=361064&anchor=Asthma-exacerbation-in-children-2-years-old . • Obstet Gynecol 2013 Feb. Asthma exacerbation in adults and adolescents. DynaMed [database on the Internet]. 2013 [cited 2013 Dec 27]. Available from: http://web.ebscohost.com/dynamed/detail?vid=4&sid=e5ed58d4-1dcb-4a1c-9314- b0746cccae77%40sessionmgr113&hid=120&bdata=JnNpdGU9ZHluYW1lZC1saXZlJ nNjb3BlPXNpdGU%3d#db=dme&AN=114076 . • Cochrane Database Syst Rev 2012 Dec 12. Inhaled corticosteroids for acute asthma in adults and adolescents. DynaMed [database on the Internet]. 2013 [cited 2013 Dec 27]. Available from: http://web.ebscohost.com/dynamed/detail?vid=4&sid=e5ed58d4- 1dcb-4a1c-9314 b0746cccae77%40sessionmgr113&hid=120&bdata=JnNpdGU9ZHluYW1lZC1saXZlJ nNjb3BlPXNpdGU%3d#db=dme&AN=361022 . • DUNCAN KEELEY, MICHAEL MCKEAN. Asthma and Other Wheezing Disorders in Children. Am Fam Physician. 2006 Dec 1; 74(11):1901-1905. • Marcia L. Edmonds, Md, Msc; Carlos A. Camargo, Jr., Md, Drph, Fccp; Barry E. Brenner, Md, Phd, Fccp; Brian H. Rowe, Md, Msc. Replacement of Oral Corticosteroids With Inhaled Corticosteroids in the Treatment of Acute Asthma Following Emergency Department Discharge*: A Meta-analysis. Chest. 2002; 121(6):1798-1805. doi:10.1378/chest.121.6.1798 [homepage on the Internet].[cited 2013 Dec 27]. Available from: http://journal.publications.chestnet.org/article.aspx?articleid=1080705 .