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Placebo controlled trial of systemic corticosteroids in acute childhood asthma
J G Gleeson1, B G Loftus, J F Price
1Department of Paediatrics, King's College Hospital, London, UK.
Insights
Systemic corticosteroids significantly improved outcomes for children hospitalized with acute severe asthma. Steroid treatment led to reduced heart rates, better lung function, and more children being wheeze-free upon discharge.
Area of Science:
- Pediatric Pulmonology
- Clinical Medicine
- Pharmacology
Background:
- Acute severe asthma in children often requires hospitalization.
- The role of systemic corticosteroids in non-steroid-dependent acute severe asthma is debated.
- Standard treatment includes bronchodilators and aminophylline.
Purpose of the Study:
- To evaluate the efficacy of systemic corticosteroids as an adjunct to standard treatment for acute severe asthma in children.
- To assess the impact of corticosteroids on clinical and physiological parameters during hospitalization and follow-up.
Main Methods:
- A randomized controlled trial involving 38 children (aged 2-11 years) with acute severe asthma.
- Participants received nebulized salbutamol and intravenous aminophylline plus either hydrocortisone/prednisolone or placebo for 5 days.
- Clinical observations, heart rate, Peak Expiratory Flow Rates (PEFR), respiratory rate, pulsus paradoxus, and arterial oxygen saturation were monitored.
Main Results:
- The steroid group showed a greater reduction in heart rate on day 2 and at discharge.
- Improved Peak Expiratory Flow Rates (PEFR) were observed in the steroid group on day 2.
- More children in the steroid group were clinically wheeze-free at hospital discharge (9 vs. 3).
- Trends favored active treatment for shorter hospital stays and lower relapse rates.
Conclusions:
- Systemic corticosteroids, when added to high-dose bronchodilators, are beneficial for hospitalized children with acute severe asthma.
- Corticosteroids improve physiological parameters and clinical symptoms in this patient population.
- These findings support the use of systemic corticosteroids in 'non steroid dependent' children with severe asthma exacerbations.
Abstract:
In a randomised controlled trial 38 asthmatic children aged 2-11 yr who had not received regular oral or inhaled steroids during the previous year, were treated with a standard regime of nebulised salbutamol and intravenous aminophylline plus either hydrocortisone and oral prednisolone for 5 days, or placebo. The children were observed throughout their hospital stay and for 3 months afterwards. There was a greater fall in heart rates in the steroid treated group on the second day of treatment (mean diff. 16 beats/min) and at discharge (mean diff. 13 beats/min); p less than 0.025. Peak Expiratory Flow Rates recorded in 26 children, 13 in each group, showed more improvement on day 2 in those given steroids (mean diff 16% predicted); p less than 0.05. This difference was not apparent at discharge but 9 children treated with steroids were clinically wheeze-free when they left hospital compared with 3 in the placebo group, p less than 0.05. There were no differences in respiratory rate, pulsus paradoxus and arterial oxygen saturation. Trends in duration of hospital stay and relapse rate during the succeeding 3 months favoured active treatment. These findings support the use of systemic corticosteroids in addition to high dose bronchodilators to treat 'non steroid dependent' children hospitalised with acute severe asthma.