Oral versus intravenous steroids in acute exacerbation of asthma--randomized controlled study

Abstract

Background: Use of corticosteroids in asthma is a must however the route of administration of steroid in acute exacerbation is a matter of debate. Intravenous steroids used very frequently in clinical practice may not offer any advantage over oral steroids.

Aim: To compare to the efficacy of oral vs intravenous steroids in adults admitted with acute exacerbation of bronchial asthma.

Methods: Adults admitted to hospital with acute exacerbation of asthma were randomized to receive oral prednisolone 100 mg once daily or hydrocortisone 100 mg i.v. 6 hourly for 72 hrs following admission. All patients concurrently received inhaled corticosteroids and bronchodilators. Improvements in peak expiratory flow rate (PEF) from baseline were compared for 72 hrs.

Results: A total of 65 patients were randomized, 34 received oral prednisolone and 31 received intravenous hydrocortisone. Both groups were matched at baseline for age (40 +/- 13.11 vs 44 +/- 16.23, p 0.27) and percentage prediction both pre (20.11% +/- 6.17 vs 20.58% +/- 4.78, p 0.73) and post bronchodilator (24.35% +/- 5.43 vs 25.38% +/- 5.01, p 0.43). After 72 hrs both groups had improvement in PEF which was statistically insignificant (53.23% +/- 9.54 vs 55.87% +/- 10.34, p 0.28).

Conclusion: Corticosteroids administered orally and IV had similar efficacy in the treatment of adults hospitalized with acute exacerbation of bronchial asthma.