Oral versus intravenous corticosteroids in adults hospitalised with acute asthma.
BACKGROUND
Systemic corticosteroids are routinely used in the management of acute asthma, however the optimum route of administration for patients requiring hospitalisation is unclear. Intravenous (IV) corticosteroids are used in practice, but they may not offer any advantage over oral corticosteroids.


OBJECTIVE
To compare the efficacy of oral and IV administration of corticosteroids in the treatment of adults hospitalised with acute asthma.


METHODS
Adults admitted to hospital for treatment of acute asthma were randomised to receive oral prednisolone 100 mg once daily or hydrocortisone 100 mg IV 6 hourly for 72 h following admission. All patients concurrently received inhaled corticosteroids and bronchodilators. Improvements in peak expiratory flow rate (PEF) from baseline were compared for 72 h.


RESULTS
Forty-seven patients were randomized, 30 females, 17 males. Twenty-four received oral prednisolone and 23 received IV hydrocortisone. At baseline the oral and IV groups were similar (mean, SD) in age (38.3, 12.8 vs 37.3, 12.9, P=0.80) and initial percent predicted (PP) PEF (61, 16.7 vs 69, 13.0, P=0.11). After 72 h both groups had similar improvements in PEF (27%, 26 vs 27%, 19, P=0.96).


CONCLUSIONS
Corticosteroids administered orally and IV had similar efficacy in the treatment of adults hospitalised with acute asthma.
Cunnington
D
D
Department of Respiratory and Sleep Disorders Medicine, Western Hospital, Gordon Street, Footscray, Vic. 3011, Australia. david.cunnington@wh.org.au
Smith
N
N
Steed
K
K
Rosengarten
P
P
Kelly
A M
AM
Teichtahl
H
H
D000284:Administration, Oral; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D005540:Forced Expiratory Flow Rates / Q000187:drug effects; D005938:Glucocorticoids / Q000008:administration & dosage / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000627:therapeutic use*; D007275:Injections, Intravenous; D007902:Length of Stay; D008297:Male; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D011239:Prednisolone; D006854:Hydrocortisone