CONTROLLED TRIAL OF ORAL PREDNISONE IN THE EMERGENCY DEPARTMENT TREATMENT OF CHILDREN WITH ACUTE ASTHMA

Background. Recent studies have shown that the use of parenteral corti costeroids in the emergency department decreases the hospitalization r ate for patients with acute asthma. We studied the efficacy of oral co rticosteroids in the emergency department treatment of moderately ill children with acute asthma. Methods. Emergency department patients age d 1 through 17 years whose chief complaint was acute asthma were assig ned a pulmonary index, based on clinical evaluation. Those with a mode rate exacerbation (pulmonary index = 9 through 13) received either 2 m g/kg of oral prednisone or placebo in a randomized, double-blind fashi on. Patients in each group were then treated with an identical regimen of frequent aerosolized albuterol, for up to a maximum of 4 hours. Re sults. Seventy-five patients were assessed. Overall 11 (31%) of 36 in the prednisone group required hospitalization compared with 19 (49%) o f 39 in the placebo group (P = .10). Among the sickest patients (initi al pulmonary index > 10), 7 (32%) of 22 prednisone-treated patients re quired hospitalization compared with 13 (72%) of 18 placebo-treated pa tients (P < .05). Among patients who had a suboptimal response to init ial beta2-agonist therapy and who therefore would have been hospitaliz ed had treatment been restricted to 2 hours, 9 (45%) of 20 in the pred nisone group ultimately required hospitalization when duration of care was extended 2 additional hours compared with 15 (83%) of 18 in the p lacebo group (P < .05). In addition, prednisone-treated patients had a significantly greater improvement in median pulmonary index (5.0 vs 3 .0, P < .001). Conclusions. These data demonstrate that oral prednison e, within 4 hours of its administration, reduced the need for hospital ization among a subset of children treated in the emergency department for acute asthma.