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 [FEV₁] < 60% predicted for height in patients aged 7 to 18 years and as Pulmonary Index Score [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 FEV₁ 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 FEV₁ 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 rood moderate to severe asthma exacerbation, hospital admission rates are similar in children given oral methylprednisolone and those given IV methylprednisolone.