Intravenous versus oral corticosteroids in the management of acute asthma in children

Study objective: To determine whether oral corticosteroids are significantly better at preventing the need for hospital admission than IV corticosteroids 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 asthma (defined as forced expiratory volume in 1 second [FEV(1)] < 60% predicted far height in patients aged 7 to 18 years and as Pulmonary Index Scare [PIS] between 6 and 11 for patients aged 18 months through 6 years). Patients were randomized to receive 2 mg/kg oral methylprednisolone or 2 mg/kg IV methylprednisolone 30 minutes after the initial treatment with nebulized albuterol. Each patient was otherwise treated with an identical regimen of frequent nebulized albuterol and IV theophylline for a total of 4 hours. Results: Forty-nine patients were enrolled. Four hours after treatment, both groups had similar respiratory rates, oxygen saturation, PISs, and FEV(1) values. Eleven of 23 patients 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 for the 2% difference in admission rate to the hospital (favoring oral methylprednisolone) ranged from 21% (favoring IV methylprednisolone) to 25% (favoring oral methylprednisolone). Patients discharged home demonstrated 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 children with moderate to severe asthma exacerbation, hospital admission rates are similar in children given oral methylprednisolone and those given IV methylprednisolone.