We identified 19 eligible studies (3459 individuals), all observational; 13 studies (1917 individuals) were suitable for inclusion in the meta-analysis of mortality . Of these, 12 studied patients infected with 2009 influenza A H1N1 virus (H1N1pdm09). Risk of bias was greatest in the 'comparability domain' of the Newcastle-Ottawa scale, consistent with potential confounding by indication. Data specific to mortality were of very low quality. Reported doses of corticosteroids used were high and indications for their use were not well reported. On meta-analysis , corticosteroid therapy was associated with increased mortality ( odds ratio ( OR ) , 95% confidence interval ( CI ) to ). Pooled subgroup analysis of adjusted estimates of mortality from four studies found a similar association ( OR , 95% CI to ). Three studies reported greater odds of hospital-acquired infection related to corticosteroid therapy ; all were unadjusted estimates and we graded the data as very low quality.
The term eosinophilic bronchitis is reserved for patients who again respond to anti-asthma medication but do not exhibit either bronchoconstriction or bronchial hyperresponsiveness. As the term implies sputum examination reveals eosinophils. Whether eosinophilic bronchitis represents a separate disease or is part of a spectrum of asthma is hotly debated and obviously depends on which definition of asthma is used. Patients with eosinophilic bronchitis may be relatively resistant to anti-asthma therapy, only responding to high doses of parenteral steroids or more severe immunosuppression. Attempting to control the disease is important since a proportion of these patients do on to develop fixed airflow obstruction or bronchiectasis.
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