Effectiveness and safety of inhaled corticosteroids in controlling acute asthma attacks in children who were treated in the emergency department: A controlled comparative study with oral prednisolone,☆☆,,★★

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Abstract

Background: Inhaled corticosteroids have a greater antiinflammatory potency and fewer systemic effects than intravenous, intramuscular, or oral corticosteroids. However, their role in acute asthma has not been established. We prospectively investigated the efficacy and safety of inhaled corticosteroids in controlling moderately severe acute asthma attacks in children who were treated in the emergency department. Methods: Children who were treated in the emergency department with moderately severe asthma attacks after receiving treatment with inhaled terbutaline were allocated by double-blind design to receive 1 dose of either 1600 μg budesonide turbohaler or 2 mg/kg prednisolone. The pulmonary index score and peak expiratory flow rate were measured hourly for the first 4 hours. After discharge the children were treated with the same initial doses given 4 times daily, followed by a 25% reduction in dose every second day for 1 week. Parents recorded asthma symptoms and use of β-2 agonists on a daily diary card. Serum cortisol concentration was measured at the end of weeks 1 and 3. Results: Twenty-two children (11 in each group) with similar baseline parameters completed the study. There was a similar improvement in pulmonary index score and peak expiratory flow rate in the 2 groups. Children treated with budesonide showed an earlier clinical response than those given prednisolone, who also showed a decrease in serum cortisol concentration. Conclusion: In children with moderately severe asthma attacks who were treated in the emergency department, a short-term dose schedule of inhaled budesonide turbohaler, starting with a high dose and followed by a decrease over 1 week, is at least as effective as oral prednisolone, without suppressing serum cortisol concentration. (J Allergy Clin Immunol 1998;102:605-9.)

Section snippets

METHODS

The study population included children aged 6 to 16 years with well-diagnosed asthma who were treated in the ED with a moderately severe acute asthma attack, defined by a peak expiratory flow rate (PEFR) of 35% to 75% of predicted values and a pulmonary index score4 of 8 to 13 (maximal score, 15). Other prerequisites were the ability to correctly operate the turbohaler; the absence of acute febrile illness; freedom from regular treatment with antiasthma controller drugs including inhaled

RESULTS

Twenty-four children who were treated in the ED with an acute asthma attack started the trial; 1 child was later excluded because of pneumonia, and another for noncompliance. Of the 22 children who completed the study, 11 were treated with inhaled budesonide and 11 with oral prednisolone. The 2 groups were similar for demographic parameters, asthma morbidity in the 3 months preceding the study, and asthma status after the onset of the index asthma attack (Table II).

There were no significant

DISCUSSION

International guidelines on asthma management recommend a short course of 1 to 2 mg/kg/day of oral or intravenous prednisolone with β2 agonists for the treatment of acute severe asthma.16, 17 Some studies have found that a single administration of high-dose intravenous6 or oral4, 18 corticosteroids is also effective in controlling acute asthma attacks within 4 hours in both adults6 and children.4, 18 This was not confirmed by others.7, 8 Barnett et al9 reported that 2 mg/kg oral

Acknowledgements

We thank Mrs Gloria Ganzach for editorial assistance.

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From a the Asthma Clinic, Department of Pediatrics C, Schneider Children’s Medical Center of Israel, Petah Tikva, Sackler School of Medicine, Tel Aviv University; and b the Pediatric Pulmonary Unit, Rambam Hospital, Technion Israel Institute of Technology, Faculty of Medicine, Haifa.

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Supported in part by Astra-Draco, Sweden.

Reprint requests: Benjamin Volovitz, MD, Head, Asthma Clinic, Department of Pediatrics C, Schneider Children’s Medical Center of Israel, 14 Kaplan St, Petah Tikva 49202, Israel.

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