INTRAVENOUS VERSUS ORAL CORTICOSTEROIDS IN THE MANAGEMENT OF ACUTE ASTHMA IN CHILDREN

Study objective: To determine whether oral corticosteroids are signifi cantly better at preventing the need for hospital admission than IV co rticosteroids in children with moderate to severe asthma exacerbation. Methods: We carried out a randomized, double-blind, controlled trial of patients in the emergency department of a tertiary urban children's hospital. Patients who presented to the ED with moderate to severe as thma (defined as forced expiratory volume in 1 second [FEV(1)] < 60% p redicted far height in patients aged 7 to 18 years and as Pulmonary In dex Scare [PIS] between 6 and 11 for patients aged 18 months through 6 years). Patients were randomized to receive 2 mg/kg oral methylpredni solone or 2 mg/kg IV methylprednisolone 30 minutes after the initial t reatment with nebulized albuterol. Each patient was otherwise treated with an identical regimen of frequent nebulized albuterol and IV theop hylline for a total of 4 hours. Results: Forty-nine patients were enro lled. Four hours after treatment, both groups had similar respiratory rates, oxygen saturation, PISs, and FEV(1) values. Eleven of 23 patien ts in the oral group (48%) and 13 of 26 patients in the IV group (50%) were admitted to the hospital (P=.88). The 90% confidence interval fo r the 2% difference in admission rate to the hospital (favoring oral m ethylprednisolone) ranged from 21% (favoring IV methylprednisolone) to 25% (favoring oral methylprednisolone). Patients discharged home demo nstrated greater improvement from baseline with regard to PIS and FEV, than patients who were admitted. Two patients in each group failed to complete the standard treatment or returned to the hospital within 48 hours of ED discharge. Conclusion: These data suggest that for childr en with moderate to severe asthma exacerbation, hospital admission rat es are similar in children given oral methylprednisolone and those giv en IV methylprednisolone.