Oral versus intravenous corticosteroids in children hospitalized with asthma

Background: Previous studies have demonstrated that in the emergency treatm ent of an asthma exacerbation, corticosteroids used in conjunction with bet a-agonists result in lower hospitalization rates for children and adults. F urthermore, orally administered corticosteroids have been found to be effec tive in the treatment of outpatients with asthma, However, similar data in inpatients is lacking. Objective: The purpose of this study was to determine the efficacy of oral prednisone versus intravenous methylprednisolone in equivalent doses for th e treatment of an acute asthma exacerbation in hospitalized children. Methods: We conducted a randomized, double-blind, double-placebo study comp aring oral prednisone at 2 mg/kg/dose (maximum 120 mg/dose) twice daily ver sus intravenous methylprednisolone at 1 mg/kg/dose (maximum 60 mg/dose) fou r times daily in a group of patients 2 through 18 years of age hospitalized for an acute asthma exacerbation. All patients were assessed by a clinical asthma score 3 times a day. The main study outcome was length of hospitali zation; total length of stay and time elapsed before beta-agonists could be administered at 6-hour intervals. Duration of supplemental oxygen administ ration and peak flow measurements were secondary outcome measures. Results: Sixty-six patients were evaluated. Children in the prednisone grou p had a mean length of stay of 70 hours compared with 78 hours for the meth ylprednisolone group (P = .52). Children in the prednisone group were succe ssfully weaned to beta-agonists in 6-hour intervals after 59 hours compared with 68 hours for the methylprednisolone group (P = .47). Patients receivi ng prednisone required supplemental oxygen for 30 hours compared with 52 ho urs for the methylprednisolone group (P = .04). Conclusion: There was no difference in length of hospital stay between asth matic patients receiving oral prednisone and those receiving intravenous me thylprednisolone. Because hospitalization charges are approximately 10 time s greater for intravenous methylprednisolone compared with oral prednisone, the use of oral prednisone to treat inpatients with acute asthma would res ult in substantial savings.