Second-line treatment option for children aged 18 years and under with an acute severe asthma exacerbation: a systematic review and meta-analysis of randomised controlled trials
Bibliographic record
Abstract
Importance Evidence regarding second-line treatment for severe asthma is limited. Objectives To evaluate the safety and efficacy of intravenous aminophylline, intravenous short-acting beta agonist (SABA), intravenous magnesium sulphate, intravenous ketamine or subcutaneous adrenaline as a second-line treatment for severe asthma. Methods We included only randomised controlled trials (RCTs) and followed the international guidelines for conducting systematic reviews. We performed a comprehensive literature search up to May 2024. Outcomes included morbidity, escalation of care, length of hospital stay, adverse events, mortality and changes in lung functions. Results Nine RCTs were included (total participants=546). Compared with other treatments, intravenous aminophylline showed no significant difference in the duration of hospital stay in hours, except for critically ill ventilated patients who had a shorter stay (mean difference (MD)=−12.99, 95 % CI −33.13 to 7.15). The need for additional intravenous medications (RR=2.17, 95 % CI 0.48 to 9.71) and asthma severity scores postinterventions (MD=0.97, 95 % CI −0.91 to 2.85) was similar. More nausea and emesis were observed in the intravenous aminophylline group. The intravenous SABA group showed no difference in hospital stay (MD=−10.12, 95 % CI −45.74 to 25.49) or need for ventilation (RR=0.25, 95 % CI 0.03 to 2.21). There were no frequent serious adverse events. The intravenous magnesium sulphate group had a lower hospitalisation rate (RR=1.52, 95 % CI 1.26 to 1.84), reduced need for additional intravenous medication (RR=6.30, 95 % CI 2.62 to 15.17) and a rapid improvement in asthma severity scores (p<0.05). Conclusion There is low-to-very-low certainty evidence demonstrating the superiority of any intravenous second-line treatment options for acute asthma. PROSPERO registration number CRD42023405226.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.026 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.025 | 0.034 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".