A comparison of inhaled fluticasone and oral prednisone for children with severe acute asthma

Background Inhaled corticosteroids are effective in the treatment of childr en with asthma. It is uncertain how inhaled corticosteroids compare with or al corticosteroids in the management of severe acute disease. Methods We performed a double-blind, randomized trial involving 100 childre n five years of age or older who had severe acute asthma ( indicated by a f orced expiratory volume in one second [FEV1] that was less than 60 percent of the predicted value) and in whom the results could be evaluated. All wer e treated with an aggressive bronchodilator regimen and received one dose o f either 2 mg of inhaled fluticasone through a metered-dose inhaler with a spacer or 2 mg of oral prednisone per kilogram of body weight. They were as sessed hourly for up to four hours. Results The mean (+/- SD) base-line FEV1 as a percentage of the predicted v alue was 46.3 +/- 12.5 in the fluticasone group (51 subjects) and 43.9 +/- 9. 9 in the prednisone group (49 subjects). The FEV1 increased by a mean of 9.4 +/- 12.5 percentage points in the fluticasone group and by 18.9 +/- 9. 8 percentage points in the prednisone group four hours after therapy (P< 0. 001). None of the children in the prednisone group had a reduction in FEV1 as a percentage of the predicted value from base line to four hours, as com pared with 25 percent of those in the fluticasone group (P< 0.001). Sixteen (31 percent) of the children treated with fluticasone were hospitalized, a s compared with five (10 percent) of those treated with prednisone (P=0.01) . Conclusions Children with severe acute asthma should be treated with oral p rednisone and not with inhaled fluticasone or a similar inhaled corticoster oid. (N Engl J Med 2000; 343: 689-94.) (C) 2000, Massachusetts Medical Soci ety.