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Oral versus intravenous corticosteroids in children hospitalized with asthma
J M Becker1, A Arora, R J Scarfone
1Department of Pediatrics, MCP Hahnemann School of Medicine, Pennsylvania, Philadelphia, USA.
Insights
Oral prednisone is as effective as intravenous methylprednisolone for treating pediatric asthma exacerbations in hospitalized children. Using oral prednisone can lead to significant cost savings for inpatient asthma care.
Area of Science:
- Pediatric Emergency Medicine
- Pulmonology
- Clinical Pharmacology
Background:
- Corticosteroids combined with beta-agonists reduce hospitalization for asthma exacerbations.
- Oral corticosteroids are effective for outpatient asthma treatment.
- Data on oral corticosteroid efficacy for inpatient asthma exacerbations is limited.
Purpose of the Study:
- To compare the efficacy of oral prednisone versus intravenous methylprednisolone in equivalent doses for hospitalized children with acute asthma exacerbations.
Main Methods:
- A randomized, double-blind, double-placebo study compared oral prednisone (2 mg/kg/dose twice daily) with intravenous methylprednisolone (1 mg/kg/dose four times daily) in children aged 2-18 years.
- Clinical asthma scores were assessed thrice daily.
- Primary outcome was length of hospitalization; secondary outcomes included time to beta-agonist administration, oxygen duration, and peak flow.
Main Results:
- No significant difference in mean length of hospitalization between prednisone (70 hours) and methylprednisolone (78 hours) groups (P =.52).
- Time to beta-agonist administration was similar (59 hours vs. 68 hours; P =.47).
- Patients receiving prednisone required significantly less supplemental oxygen (30 hours vs. 52 hours; P =.04).
Conclusions:
- Oral prednisone and intravenous methylprednisolone show comparable efficacy in treating pediatric inpatient asthma exacerbations.
- Oral prednisone is a more cost-effective option, potentially saving substantial hospitalization costs.
Background:
Previous studies have demonstrated that in the emergency treatment of an asthma exacerbation, corticosteroids used in conjunction with beta-agonists result in lower hospitalization rates for children and adults. Furthermore, orally administered corticosteroids have been found to be effective 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 the treatment of an acute asthma exacerbation in hospitalized children.
Methods:
We conducted a randomized, double-blind, double-placebo study comparing oral prednisone at 2 mg/kg/dose (maximum 120 mg/dose) twice daily versus intravenous methylprednisolone at 1 mg/kg/dose (maximum 60 mg/dose) four 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 hospitalization; total length of stay and time elapsed before beta-agonists could be administered at 6-hour intervals. Duration of supplemental oxygen administration and peak flow measurements were secondary outcome measures.
Results:
Sixty-six patients were evaluated. Children in the prednisone group had a mean length of stay of 70 hours compared with 78 hours for the methylprednisolone group (P =.52). Children in the prednisone group were successfully weaned to beta-agonists in 6-hour intervals after 59 hours compared with 68 hours for the methylprednisolone group (P =.47). Patients receiving prednisone required supplemental oxygen for 30 hours compared with 52 hours for the methylprednisolone group (P =.04).
Conclusion:
There was no difference in length of hospital stay between asthmatic patients receiving oral prednisone and those receiving intravenous methylprednisolone. Because hospitalization charges are approximately 10 times greater for intravenous methylprednisolone compared with oral prednisone, the use of oral prednisone to treat inpatients with acute asthma would result in substantial savings.
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