A Comparison of Oral Dexamethasone With Oral Prednisone in Pediatric Asthma Exacerbations Treated in the Emergency Department Two days of dexamethasone versus 5 days of prednisone in the treatment of acute asthma: a randomized controlled trial. Single dose oral dexamethasone versus multi-dose prednisolone in the treatment of acute exacerbations of asthma in children who attend the emergency department: study protocol for a randomized controlled trial Crushed prednisolone tablets or oral solution for acute asthma? A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department. Single-Dose Oral Dexamethasone in the Emergency Management of Children With Exacerbations of Mild to Moderate Asthma A 5- versus 3-day course of oral corticosteroids for children with asthma exacerbations who are not hospitalised: a randomised controlled trial. Randomised pragmatic comparison of UK and US treatment of acute asthma presenting to hospital Duration of systemic corticosteroids in the treatment of asthma exacerbation; a randomized study. High-dose corticosteroids in severe acute asthma. A comparison of 'abruptly stopping' with 'tailing off' oral corticosteroids in acute asthma. Tapering of corticosteroid therapy following exacerbation of asthma. A randomized, double-blind, placebo-controlled trial. [Comparative study of the effectiveness of 2 oral corticoids in the control of severe crisis of bronchial asthma: deflazacort and prednisone]. Randomized clinical trial of intramuscular vs oral methylprednisolone in the treatment of asthma exacerbations following discharge from an emergency department. A comparison of non-tapering vs. tapering prednisolone in acute exacerbation of asthma involving use of the low-dose ACTH test. [A comparison of a 3 day course with a 2 week course of oral prednisolone in patients with chronic asthma]. Dose response of patients to oral corticosteroid treatment during exacerbations of asthma. Adverse behavioral effects of treatment for acute exacerbation of asthma in children: a comparison of two doses of oral steroids. Prospective, placebo-controlled trial of 5 vs 10 days of oral prednisolone in acute adult asthma. Comparative efficacy of oral dexamethasone versus oral prednisone in acute pediatric asthma. Comparison of three different oral corticosteroids in steroid‐dependent asthma patients Lack of efficacy of single-dose prednisolone in moderately severe asthma. Double-blind trial of steroid tapering in acute asthma Inhaled corticosteroids in children with persistent asthma: effects on growth. Corticosteroids in acute severe asthma: effectiveness of low doses. Prednisolone in acute childhood asthma: clinical responses to three dosages. A pilot study of steroid therapy after emergency department treatment of acute asthma: is a taper needed?
The aim of this study was to determine if 2 doses of oral dexamethasone are as effective as a 5-day course of oral prednisone in preventing relapse for pediatric asthma exacerbations . Patients presenting to the emergency department with an asthma exacerbation were r and omized to receive 0.6 mg/kg of dexamethasone or 2 mg/kg of prednisone in a prospect i ve , double-blind study . The primary outcome was relapse within 10 days , and the secondary outcome was vomiting in the emergency department .  Eighty-nine patients completed the study : 38 in the prednisone group and 51 in the dexamethasone group . In all , 3 patients in the prednisone group ( 8 % ) and 8 patients in the dexamethasone group ( 16 % ) required an unscheduled follow-up visit ( P = .27 ) . In all , 7 patients in the prednisone group ( 18 % ) and 5 patients in the dexamethasone group ( 10 % ) had vomiting ( P = .24 ) . No difference was found in the relapse rate or incidence of vomiting between patients given prednisone and dexamethasone for pediatric asthma exacerbations STUDY OBJECTIVE Dexamethasone has a longer half-life than prednisone and is well tolerated orally . We compare the time needed to return to normal activity and the frequency of relapse after acute exacerbation in adults receiving either 5 days of prednisone or 2 days of dexamethasone . METHODS We r and omized adult emergency department patients ( aged 18 to 45 years ) with acute exacerbations of asthma ( peak expiratory flow rate less than 80 % of ideal ) to receive either 50 mg of daily oral prednisone for 5 days or 16 mg of daily oral dexamethasone for 2 days . Outcomes were assessed by telephone follow-up . RESULTS Ninety-six prednisone and 104 dexamethasone subjects completed the study regimen and follow-up . More patients in the dexamethasone group reported a return to normal activities within 3 days compared with the prednisone group ( 90 % versus 80 % ; difference 10 % ; 95 % confidence interval 0 % to 20 % ; P=.049 ) . Relapse was similar between groups ( 13 % versus 11 % ; difference 2 % ; 95 % confidence interval -7 % to 11 % , P=.67 ) . CONCLUSION In acute exacerbations of asthma in adults , 2 days of oral dexamethasone is at least as effective as 5 days of oral prednisone in returning patients to their normal level of activity and preventing relapse Background Asthma is a major cause of pediatric morbidity and mortality . In acute exacerbations of asthma , corticosteroids reduce relapses , subsequent hospital admission and the need for ß2-agonist therapy . Prednisolone is relatively short-acting with a half-life of 12 to 36 hours , thereby requiring daily dosing . Prolonged treatment course , vomiting and a bitter taste may reduce patient compliance with prednisolone . Dexamethasone is a long-acting corticosteroid with a half-life of 36 to 72 hours . It is used frequently in children with croup and bacterial meningitis , and is well absorbed orally . The purpose of this trial is to examine whether a single dose of oral dexamethasone ( 0.3 mg/kg ) is clinical ly non-inferior to prednisolone ( 1 mg/kg/day for three days ) in the treatment of exacerbations of asthma in children who attend the Emergency Department . Methods / design This is a r and omized , non-inferiority , open-label clinical trial . After informed consent with or without assent , patients will be r and omized to either oral dexamethasone 0.3 mg/kg stat or prednisolone 1 mg/kg/day for three days . The primary outcome measure is the comparison between the Pediatric Respiratory Assessment Measure ( PRAM ) across both groups on Day 4 . The PRAM score , a vali date d , responsive and reliable tool to determine asthma severity in children aged 2 to 16 years , will be performed by a clinician blinded to treatment allocation . Secondary outcomes include relapse , hospital admission and requirement for further steroid therapy . Data will be analyzed on an intention-to-treat and a per protocol basis . With a sample size of 232 subjects ( 105 in each group with an estimated 10 % loss to follow-up ) , we will be able to reject the null hypothesis - that the population means of the experimental and control groups are equal with a probability ( power ) of 0.9 . The Type I error probability associated with this test ( of the null hypothesis ) is 0.05 . Discussion This clinical trial may provide evidence that a shorter steroid course using dexamethasone can be used in the treatment of acute pediatric asthma , thus eliminating the issue of compliance to treatment . Registration IS RCT N26944158 and EudraCT Number 2010 - 022001 - In a r and omised trial , treatment with prednisolone in two formulations ( oral solution or crushed tablets ) was compared in 78 young children with acute asthma .  Prednisolone oral solution was better tolerated than crushed tablets ( less vomiting , superior taste ) ; clinical resolution was similar STUDY OBJECTIVE In acute exacerbations of asthma in children , corticosteroids reduce relapses , subsequent hospital admission , and the need for ß2-agonist bronchodilators . Prednisolone is the most commonly used corticosteroid , but prolonged treatment course , vomiting , and a bitter taste may reduce patient compliance . Dexamethasone has a longer half-life and has been used safely in other acute pediatric conditions . We examine whether a single dose of oral dexamethasone is noninferior to prednisolone in the emergency department ( ED ) treatment of asthma exacerbations in children , as measured by the Pediatric Respiratory Assessment Measure ( PRAM ) at day 4 . METHODS We conducted a r and omized , open-label , noninferiority trial comparing oral dexamethasone ( single dose of 0.3 mg/kg ) with prednisolone ( 1 mg/kg per day for 3 days ) in patients aged 2 to 16 years and with a known diagnosis of asthma or at least 1 previous episode of ß2-agonist-responsive wheeze who presented to a tertiary pediatric ED . The primary outcome measure was the mean PRAM score ( range of 0 to 12 points ) performed on day 4 . Secondary outcome measures included requirement for further steroids , vomiting of study medication , hospital admission , and unscheduled return visits to a health care practitioner within 14 days . RESULTS There were 245 enrollments involving 226 patients . There was no difference in mean PRAM scores at day 4 between the dexamethasone and prednisolone groups ( 0.91 versus 0.91 ; absolute difference 0.005 ; 95 % CI -0.35 to 0.34 ) . Fourteen patients vomited at least 1 dose of prednisolone compared with no patients in the dexamethasone group . Sixteen children ( 13.1 % ) in the dexamethasone group received further systemic steroids within 14 days after trial enrollment compared with 5 ( 4.2 % ) in the prednisolone group ( absolute difference 8.9 % ; 95 % CI 1.9 % to 16.0 % ) . There was no significant difference between the groups in hospital admission rates or the number of unscheduled return visits to a health care practitioner . CONCLUSION In children with acute exacerbations of asthma , a single dose of oral dexamethasone ( 0.3 mg/kg ) is noninferior to a 3-day course of oral prednisolone ( 1 mg/kg per day ) as measured by the mean PRAM score on day 4 Objective : To compare the efficacy of a single dose of oral dexamethasone ( Dex ) versus 5 days of twice-daily prednisolone ( Pred ) in the management of mild to moderate asthma exacerbations in children . Study Design : A prospect i ve , r and omized , double-blinded trial of children 2 to 16 years of age who presented to the emergency department ( ED ) with acute mild to moderate asthma exacerbations . Subjects received single-dose oral Dex ( 0.6 mg/kg to a maximum of 18 mg ) or oral Pred ( 1 mg/kg per dose to a maximum of 30 mg ) twice daily for 5 days . After discharge , subjects were contacted by telephone at 48 h to assess symptoms and reevaluated in the ED in 5 days . The primary outcome was the number of days needed for Patient Self Assessment Score to return to baseline ( score of 0 - 0.5 ) . Main Results : Baseline characteristics of the 2 groups were similar . The mean number of days needed for Patient Self Assessment Score to return to baseline ( 0 - 0.5 ) in the Dex and Pred groups were 5.21 versus 5.22 days , respectively ( mean difference , −0.01 ; confidence interval , −0.70 , 0.68 ) . Pulmonary index scores were similar in both groups at initial presentation , initial ED discharge and at the day 5 follow-up visit . At the first visit , mean time to discharge was 3.5 h (±1.93)for Dex and 4.3 h ( ±3.67 ) for Pred ( mean difference , −0.8 ; confidence interval , −1.8 , 0.2 ) . Initial admission rate was 9 % ( Dex ) versus 13.4 % ( Pred ) . There was no significant difference in the number of salbutamol therapies needed in the ED nor at home after discharge . For subjects discharged home , the admission rate after initial discharge was 4.9 % ( Dex ) versus 1.8 % ( Pred ) , result ing in overall hospital admission rates of 13.4 % ( Dex ) and 14.9 % ( Pred ) . Conclusion : A single dose of oral Dex ( 0.6 mg/kg ) is no worse than 5 days of twice-daily prednisolone ( 1 mg/kg per dose ) in the management of children with mild to moderate asthma OBJECTIVE To determine whether a 5-day course of oral prednisolone is superior to a 3-day course in reducing the 2-week morbidity of children with asthma exacerbations who are not hospitalised . DESIGN , SETTING AND PARTICIPANTS Double-blind r and omised controlled trial of asthma outcomes following a 5-day course of oral prednisolone ( 1 mg/kg ) compared with a 3-day course of prednisolone plus placebo for 2 days . Participants were children aged 2 - 15 years who presented to the emergency departments of three Queensl and hospitals between March 2004 and February 2007 with an acute exacerbation of asthma , but were not hospitalised . Sample size was defined a priori for a study power of 90 % . MAIN OUTCOME MEASURES Difference in proportion of children who were symptom-free at Day 7 , as measured by intention-to-treat ( ITT ) and per- protocol analysis ; quality of life ( QOL ) on Days 7 and 14 . RESULTS 201 children were enrolled , and there was an 82 % completion rate . There was no difference between groups in the proportion of children who were symptom-free ( observed difference , 0.04 [ 95 % CI , - 0.09 to 0.18 ] by ITT analysis ; 0.04 [ 95 % CI , - 0.17 to 0.09 ] by per- protocol analysis ) . There was also no difference between groups in QOL ( P = 0.42 ) . The difference between groups for the primary outcome was within the equivalence range calculated post priori . CONCLUSION A 5-day course of oral prednisolone confers no advantage over a 3-day course for children with asthma exacerbations who are not hospitalised . TRIAL REGISTRATION Australian Clinical Trials Registry ACTRN012605000305628 Background : Systemic corticosteroids and inhaled β2 agonists are accepted first line treatments for acute severe asthma , but there is no consensus on their optimum dosage and frequency of administration . American regimens include higher initial dosages of β2 agonists and corticosteroids than UK regimens . Methods : In a prospect i ve , pragmatic , r and omised , parallel group study , 170 patients of mean ( SD ) age 37 ( 12 ) years with acute asthma ( peak expiratory flow ( PEF ) 212 ( 80 ) l/min ) presenting to hospital received treatment with either high dose prednisolone and continuous nebulised salbutamol as recommended in the US or lower dose prednisolone and bolus nebulised salbutamol as recommended in the UK by the BTS . Results : Outcome measures were : ΔPEF at 1 hour ( BTS 89 l/min , US 106 l/min , p=0.2 , CI –8 to 41 ) and at 2 hours ( BTS 49 l/min , US 101 l/min , p<0.0001 , CI 28 to 77 ) ; time to discharge if admitted ( BTS 4 days , US 4 days ) ; rates of achieving discharge PEF ( > 60 % ) at 2 hours ( BTS 64 % , US 78 % , p=0.04 ) ; time to regain control of asthma as measured by PEF ≥80 % best with ≤20 % variability ( BTS 3 days , US 4 days , p=0.6 ) ; PEF at 24 hours in patients admitted ( BTS 293 l/min , US 288 l/min , p=0.8 ) ; and control of asthma in the subsequent month ( no significant differences ) . Conclusions : Treatment with higher doses of continuous nebulised salbutamol leads to a greater immediate improvement in PEF but the degree of recovery at 24 hours and speed of recovery thereafter is achieved as effectively with lower corticosteroid doses as recommended in the British guidelines OBJECTIVE To determine an appropriate duration for a short course of oral steroids in cases of asthma exacerbations . SETTING A 1,000 bed city hospital in Kobe , Japan . PATIENTS Patients with asthma exacerbations who needed hospital admission . METHODS Following an initial treatment with a 3-day course of intravenous methylprednisolone , patients were allocated to either a 1-week ( 1 W ) or a 2-week ( 2 W ) course of oral prednisolone ( PSL , 0.5 mg/kg ) . OUTCOME MEASURES Peak expiratory flow rate ( PEF ) and rate of unscheduled hospital visits and readmission . RESULTS Twenty patients were enrolled ( 10 in 1 W , 10 in 2 W ) .  Mean PEF just before starting oral PSL in 1 W and 2 W were 51 and 58 % of each patient 's best value . PEF was significantly improved and to a similar degree over the course of time in both 1 W and 2 W. The frequency of unexpected hospital visits during a 3-month period after discharge was similar ( 2 in 1 W and 2 in 2 W ) . No readmission occurred during the same period . CONCLUSIONS Because both the 1-week and the 2-week course of oral PSL were equally effective in the treatment of asthma exacerbations , 1 week may be appropriate as the maximum duration of a short rescue course of oral steroids Twenty-six patients admitted to hospital for treatment of severe exacerbations of asthma unresponsive to bronchodilators were assigned to high- , medium- , or low-dose corticosteroid treatment regimens . The rates of recovery were assessed by changes in pulse rate , peak expiratory flow rate , and spirometric measurements and were not related to the dose of corticosteroids given . Very high systemic doses of corticosteroids do not offer significant advantages in treating severe exacerbations of asthma Systemic corticosteroids are almost universally used in the treatment of severe acute asthma but the optimum length of treatment with corticosteroids following recovery from an acute attack of asthma is not established . Thirty-five patients admitted with acute asthma and treated with oral prednisolone 40 mg daily in addition to bronchodilator therapy until full recovery , with stable peak expiratory flow recordings ( PEF ) within 15 % of their previous best PEF or predicted PEF were studied . They were all discharged home on regular inhaled corticosteroids and regular or as required use of bronchodilators and r and omized to receive either prednisolone 40 mg daily or placebo for the first 14 days . Median PEF values increased from 31 % predicted on admission to hospital to 71 % predicted on discharge from hospital in the active treatment group ( 19 patients ) and from 32 - 73 % in the placebo group ( 16 patients ) . There was no difference between the two groups in the median values of the forced expiratory volume in one second , forced vital capacity , total lung capacity or diurnal variation in PEF either at the time of discharge from hospital or at 14 and 28 days after discharge from hospital . This study suggests that there is no need to reduce prednisolone gradually following recovery from an exacerbation of asthma , provided systemic corticosteroid treatment is continued until a satisfactory and stable PEF is achieved Systemic corticosteroids are effective in the treatment of acute asthma , but the optimal schedule for steroid withdrawal following an asthma exacerbation has not been determined . This study was design ed to test the hypothesis that tapering the corticosteroid dosage over a longer period of time reduces the number of reexacerbations .  Non-steroid-dependent adult men hospitalized for asthma exacerbations during a one-year period ( n = 43 ) were r and omly assigned to corticosteroid tapering regimens of one or seven weeks , following an eight-day course of high-dose corticosteroid therapy . There were no significant differences between the long-taper and short-taper groups in rate of reexacerbation ( 41 % vs 52 % ) or readmission ( 22 % vs 21 % ) during the 12-week study period . Patients who did not have a reexacerbation during the 12 weeks were evaluated with spirometry , with no significant differences occurring between the two groups . More patients in the long-taper group reported corticosteroid side effects ( 41 % vs 14 % ) . Patients who required mechanical ventilation during the initial hospitalization ( n = 7 ) , or who reported more than two days of worse than usual dyspnea in the 12-week period ( n = 20 ) , had high rates of reexacerbation ( 86 % and 80 % , respectively ) . These results provide reasonable certainty ( 90 % ) that a long taper does not result in a large reduction ( 50 % or more ) in reexacerbations compared with a short taper . We conclude that the relapse rate is high in this population regardless of the corticosteroid tapering regimen used , and that a long taper does not appear to provide enough benefit to justify its routine use This article contains the results reached after conducting a study with 30 patients hospitalized or seen at the Emergency Ward of the National Institute of Respiratory Diseases , diagnosed as suffering from a severe bronchial asthma crisis , in whom the crisis was controlled with conventional measures . The purpose of this study was to compare the efficacy of deflazacort and prednisone  as anti-inflammatory agents capable of controlling severe asthma crisis in addition to analyzing their side effects . Deflazacort  showed to be as effective as prednisone OBJECTIVE To compare the efficacy of long-acting IM methylprednisolone to tapering oral methylprednisolone in adult asthmatic patients discharged from the emergency department ( ED ) . METHODS R and omized , double-blind , placebo-controlled trial of a single IM dose of 160 mg depot methylprednisolone vs 8-day tapering of a total dose of 160 mg oral methylprednisolone in adult asthmatic patients ( age range , 18 to 45 years ) who were discharged from the ED following st and ardized treatment for an acute exacerbation . The primary end point was relapse , which was defined as the need to seek unscheduled care at a doctor 's office , clinic , or ED for symptoms of persistent or worsening asthma within 10 days of ED discharge . RESULTS Of 190 patients enrolled into the study , 180 completed the study and the follow-up at 10 days ( 96 % ) . The relapse rate was nearly identical for the two treatment groups ( IM administration , 14.1 % [ 13 of 92 patients ] ; oral administration , 13.6 % [ 12 of 88 patients ] ; difference , 0.5 % [ 95 % confidence interval , - 9.6 to 10.6 % ] ) . CONCLUSIONS Single-dose IM methylprednisolone administered to adult asthmatic patients at ED discharge appears to be a viable therapeutic alternative to a course of oral methylprednisolone . Clinicians may choose to base the route of administration of corticosteroids on concerns about nonadherence to therapy or on the ability of a patient to afford a prescription for outpatient medication OBJECTIVE To determine if there is a difference in early relapse rates and adrenal suppression between patients receiving an 8-day course of 40 mg/day prednisolone  and those receiving an 8-day tapering course of prednisolone . METHODS This was a prospect i ve , r and omized , open clinical trial conducted in a tertiary care center . All asthmatic patients with exacerbation who were judged well enough for discharge home from the emergency department were eligible for participation . Patients with a history of chronic obstructive pulmonary disease , congestive heart failure , pneumonia , pneumothorax , or other pulmonary process and asthmatics already using inhaled or oral steroids within 2 weeks of admission to the emergency department were excluded . Patients on discharge were administered either on 8-day course of 40 mg/day prednisolone or an 8-day tapering course of prednisolone ( tapering from 40 mg to 0 mg ) . Patients were asked to return on Day 12 for cosyntropin stimulated test and pulmonary function testing and on Day 21 for pulmonary function testing only . RESULTS A group of 13 patients treated with non-tapering course ( 40 mg/day ) of prednisolone for 8 days were compared to a group of 13 patients treated with a tapering course ( 40 mg taper by 5 mg/day ) for 8 days . There were no differences in the FEV1 percent predicted ( Days 12 and 21 ) , the incidence of relapse , or the incidence of adrenal suppression between the 2 groups . CONCLUSION In this small study , we found no significant difference in relapse rate or adrenal suppression between asthmatics receiving an 8-day tapering dose of prednisolone and those receiving 40 mg/day prednisolone upon discharge from the emergency department To investigate an appropriate duration of short course of a oral prednisolone ( PSL ) , we compare the results of a 3 day course of PSL ( 3D ) with those of a 2 week course of PSL ( 2W ) in 20 patients with chronic asthma . All subjects had been inhaling beclomethasone dipropionate ( BDP , mean daily dose : 1325 micrograms ) , and had been self-monitoring their peak expiratory flow rate ( PEF ) for at least 6 months . Mean + /- SE of the best  PSL-induced PEF in 2W ( 2W-best ) was not different from that in 3D ( 397 + /- 29 and 356 + /- 23 L/min , respectively , p = 0.26 ) . Mean weekly morning PEF/2W-best before and 1 , 2 , 3 and 4 weeks after PSL was 60 , 76 , 80 , 76 and 76 % in 2W , and 63 , 73 , 67 , 67 and 65 % in 3D , respectively . Both changes over the course of time were significant . The frequency of emergency room visits and /or unscheduled hospital visits was not significantly different between 2W and 3D . However , both the frequency of use of inhaled beta 2 agonists and the symptom score significantly decreased only in 2W . Seven patients ( 35 % ) did not need additional oral PSL during the 4-week period after initiating 3D , and among these patients , emergency room visits and /or unscheduled hospital visits were completely controlled . In conclusion , although the effect of 3D was inferior than that of 2W , it was a sufficient duration in 35 % of the patients , and thus , may be appropriate as a initial duration of rescue course of oral steroids Ten patients with asthma were treated with different doses of oral corticosteroids during three separate exacerbations . Prednisolone was given in doses of 0.2 , 0.4 , and 0.6 mg/kg body weight daily for two weeks in a double blind r and omised order ( equivalent to 14 , 28 , and 42 mg of prednisolone daily in a person weighing 70 kg ) . Patients developing an exacerbation recorded peak expiratory flow rate twice daily for two days before starting and two weeks during treatment . A dose response was shown that was significant for the difference between the peak flows , low dose less than medium dose ( p less than 0.005 ) , medium dose less than high dose ( p less than 0.001 ) at the end of treatment . These results confirm the value of treatment with oral corticosteroids in exacerbations of asthma not requiring admission to hospital and indicate that a short high dose course of corticosteroids should consist of a minimum dose of 0.6 ng prednisolone/kg body weight for a period up to two weeks OBJECTIVE To determine the relative adverse symptomatic effects and benefits of therapy with oral corticosteroids at doses of 2 mg/kg vs 1 mg/kg daily in children with acute exacerbations of asthma . METHODS Using a question naire that addressed symptoms , we conducted a prospect i ve study of the adverse effects and benefits of therapy with prednisone or prednisolone at two dose levels in 86 children who were 2 to 16 years of age with mild persistent asthma during an acute exacerbation and were unresponsive to therapy with inhaled steroids and beta-adrenergic agents .  Parents and physicians were blinded to the dose level . Children were assigned to either of the two doses by r and om allocation . Behavioral side effects were assessed via a question naire administered by a physician . Benefits were measured by the resolution of asthma symptoms ( cough , shortness of breath , and wheeze ) at the completion of the treatment with oral steroids . RESULTS Behavioral side effects , particularly anxiety ( p < 0.02 ) and aggressive behavior ( p < 0.002 ) , were twice as common in patients receiving a dose of 2 mg/kg/d . Benefits were comparable in the two groups . The number needed to harm ( ie , the number of patients receiving experimental treatment that would lead to one additional person being harmed vs patients receiving st and ard treatment ) was 6.1 for anxiety , 8.6 for hyperactivity , and 4.8 for aggressive behavior . CONCLUSIONS Because the adverse side effects were greater at the higher dose but the benefits were comparable , we recommend using an oral corticosteroid dose of 1 mg/kg daily for children with mild persistent asthma who present with an acute exacerbation of asthma BACKGROUND The optimal duration of oral steroid treatment in the management of acute adult asthma is unclear . We prospect ively studied the effect of 5 vs. 10 days of oral prednisolone in patients with acute asthma requiring hospital admission . METHODS Each patient received 40 mg of enteric-coated prednisolone daily for 5 days , followed by 5 days of 40 mg prednisolone daily ( n=24 ) or placebo  ( n=20 ) . All were given their usual inhaled asthma therapy including inhaled corticosteroids . Patients kept PEF and symptom diaries for 21 days . RESULTS For the 5-day treatment group mean ( 95 % CI ) early morning PEF was 6 ( -47,+36 ) l/min lower to day 21 ( P=0.78 ) . There was no evidence of differences in other PEF measures ( morning post-bronchodilator , evening or worst of day ) . One patient in each group had an exacerbation requiring further oral steroids during the 21-day observation period . Asthma symptom scores were worse in the 5-day group on days 6 - 21 but the significance of this finding was uncertain , as a difference had emerged by day 5 ( prior to trial entry ) . CONCLUSIONS It may be possible to reduce the st and ard steroid course to 5 days in acute adult asthma , provided all patients receive inhaled steroids and a personal asthma management plan OBJECTIVE The objective was to determine whether 2 days of oral dexamethasone ( DEX ) is more effective than 5 days of oral prednisone/prednisolone ( PRED ) in improving symptoms and preventing relapse in children with acute asthma . STUDY DESIGN This was a prospect i ve r and omized trial of children ( 2 to 18 years old ) who presented to the emergency department with acute asthma .  PRED 2 mg/kg , maximum 60 mg ( odd days ) or DEX 0.6 mg/kg , maximum 16 mg ( even days ) was used . At discharge children in the PRED group were prescribed 4 daily doses ( 1 mg/kg/d , maximum 60 mg ) ; children in the DEX group received a prepackaged dose ( 0.6 mg/kg , maximum 16 mg ) to take the next  day . The primary outcome was relapse within 10 days . RESULTS When DEX was compared with PRED , relapse rates ( 7.4 % of 272 vs 6.9 % of 261 ) , hospitalization rates from the emergency department ( 11 % vs 12 % ) or after relapse ( 20 % vs 17 % ) , and symptom persistence at 10 days ( 22 % vs 21 % ) were similar . In the PRED group more children were excluded for vomiting in the emergency department ( 3 % vs 0.3 % ; P = .008 ) , more parents were noncompliant ( 4 % vs. 0.4 % ; P = .004 ) , and more children missed > or = 2 days of school ( 19.5 % vs. 13.2 % ; P = .05 ) . CONCLUSION In children with acute asthma , 2 doses of dexamethasone provide similar efficacy with improved compliance and fewer side effects than 5 doses of prednisone not only respiratory allergy , but also purely dermatologic symptoms ( 4 ) . Since positive reactions to uningested foods in RAST or skin prick tests predict cutaneous or respiratory symptoms after exposure to these foods ( 5 ) , such tests performed on infants with early onset atopic dermatitis from high-risk families should routinely include the foods mainly causing allergic reactions , even though previously uningested , such as cereals , egg , and cow ’s milk OBJECTIVE To assess the effectiveness of single-dose prednisolone in reducing the length of illness and hospital stay in children admitted with moderately severe asthma . DESIGN A r and omised , double-blind , controlled trial of a single dose of prednisolone in 64 children presenting with an acute attack of asthma with arterial oxygen saturation less than 93 % . RESULTS No significant differences in the rate of recovery of oxygen saturation , lung function measurements or duration of hospital stay were found . CONCLUSIONS This study failed to confirm the benefit of a single dose of prednisolone in the management of children with acute severe asthma It is customary to tail off the dose of oral steroids after treatment of an acute exacerbation of asthma ; the main reason for this practice is to avoid rebound asthma . We have carried out a r and omised double-blind study to find out whether a tapering course of oral prednisolone has any advantage over an abruptly terminated course of prednisolone for an episode of acute asthma requiring hospital admission . We studied 35 patients admitted to hospital with acute asthma ; their mean peak expiratory flow rate ( PEFR ) on admission was 173 L/min and their mean age was 32 years ( range 18 - 55 ) ; all were using inhaled steroids on discharge ( mean dose 908 micrograms daily ) . Each patient received 40 mg enteric-coated prednisolone daily for 10 days followed by a tapering course of either prednisolone 5 mg tablets ( active taper ) or identical placebo tablets ( placebo taper ) , reducing from 7 tablets on day 11 to no tablets by day 18 . The primary outcome measure was the PEFR on waking . Both groups responded well to treatment by day 10 ( mean morning PEFR : active taper group 396 L/min , placebo taper group 391 L/min ) . There was no further significant change in PEFR in either group during the 7 days of active or placebo tapering or during the following 10 days ( repeated measures analysis of variance , active vs placebo , p = 0.82 ) . The groups were also similar in terms of secondary outcome measures --symptom scores , PEFR after morning bronchodilator treatment , evening PEFR , and treatment failures . This study suggests that steroid tapering is unnecessary in acute asthma ; a personal asthma management plan with a reserve course of prednisolone may be more appropriate BACKGROUND Treatment guidelines for asthma recommend inhaled corticosteroids ( ICS ) as first-line therapy for children with persistent asthma . Although ICS treatment is generally considered safe in children , the potential systemic adverse effects related to regular use of these drugs have been and continue to be a matter of concern , especially the effects on linear growth . OBJECTIVES To assess the impact of ICS on the linear growth of children with persistent asthma and to explore potential effect modifiers such as characteristics of available treatments ( molecule , dose , length of exposure , inhalation device ) and of treated children ( age , disease severity , compliance with treatment ) . SEARCH METHODS We search ed the Cochrane Airways Group Specialised Register of trials ( CAGR ) , which is derived from systematic search es of bibliographic data bases including CENTRAL , MEDLINE , EMBASE , CINAHL , AMED and PsycINFO ; we h and search ed respiratory journals and meeting abstract s. We also conducted a search of Clinical Trials.gov and manufacturers ' clinical trial data bases to look for potential relevant unpublished studies . The literature search was conducted in January 2014 . SELECTION CRITERIA Parallel-group r and omised controlled trials comparing daily use of ICS , delivered by any type of inhalation device for at least three months , versus placebo or non-steroidal drugs in children up to 18 years of age with persistent asthma . DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection , data extraction and assessment of risk of bias in included studies . We conducted meta-analyses using the Cochrane statistical package RevMan 5.2 and Stata version 11.0 . We used the r and om-effects model for meta-analyses . We used mean differences ( MDs ) and 95 % CIs as the metrics for treatment effects . A negative value for MD indicates that ICS have suppressive effects on linear growth compared with controls . We performed a priori planned subgroup analyses to explore potential effect modifiers , such as ICS molecule , daily dose , inhalation device and age of the treated child . MAIN RESULTS We included 25 trials involving 8471 ( 5128 ICS-treated and 3343 control ) children with mild to moderate persistent asthma . Six molecules ( beclomethasone dipropionate , budesonide , ciclesonide , flunisolide , fluticasone propionate and mometasone furoate ) given at low or medium daily doses were used during a period of three months to four to six years . Most trials were blinded and over half of the trials had drop out rates of over 20 % . Compared with placebo or non-steroidal drugs , ICS produced a statistically significant reduction in linear growth velocity ( 14 trials with 5717 participants , MD -0.48 cm/y , 95 % CI -0.65 to -0.30 , moderate quality evidence ) and in the change from baseline in height ( 15 trials with 3275 participants ; MD -0.61 cm/y , 95 % CI -0.83 to -0.38 , moderate quality evidence ) during a one-year treatment period . Subgroup analysis showed a statistically significant group difference between six molecules in the mean reduction of linear growth velocity during one-year treatment ( Chi(2 ) = 26.1 , degrees of freedom ( df ) = 5 , P value < 0.0001 ) . The group difference persisted even when analysis was restricted to the trials using doses equivalent to 200 μg/d hydrofluoroalkane (HFA)-beclomethasone . Subgroup analyses did not show a statistically significant impact of daily dose ( low vs medium ) , inhalation device or participant age on the magnitude of ICS-induced suppression of linear growth velocity during a one-year treatment period . However , head-to-head comparisons are needed to assess the effects of different drug molecules , dose , inhalation device or patient age . No statistically significant difference in linear growth velocity was found between participants treated with ICS and controls during the second year of treatment ( five trials with 3174 participants ; MD -0.19 cm/y , 95 % CI -0.48 to 0.11 , P value 0.22 ) . Of two trials that reported linear growth velocity in the third year of treatment , one trial involving 667 participants showed similar growth velocity between the budesonide and placebo groups ( 5.34 cm/y vs 5.34 cm/y ) , and another trial involving 1974 participants showed lower growth velocity in the budesonide group compared with the placebo group ( MD -0.33 cm/y , 95 % CI -0.52 to -0.14 , P value 0.0005 ) . Among four trials reporting data on linear growth after treatment cessation , three did not describe statistically significant catch-up growth in the ICS group two to four months after treatment cessation . One trial showed accelerated linear growth velocity in the fluticasone group at 12 months after treatment cessation , but there remained a statistically significant difference of 0.7 cm in height between the fluticasone and placebo groups at the end of the three-year trial . One trial with follow-up into adulthood showed that participants of prepubertal age treated with budesonide 400 μg/d for a mean duration of 4.3 years had a mean reduction of 1.20 cm ( 95 % CI -1.90 to -0.50 ) in adult height compared with those treated with placebo . AUTHORS ' CONCLUSIONS Regular use of ICS at low or medium daily doses is associated with a mean reduction of 0.48 cm/y in linear growth velocity and a 0.61-cm change from baseline in height during a one-year treatment period in children with mild to moderate persistent asthma . The effect size of  ICS on linear growth velocity appears to be associated more strongly with the ICS molecule than with the device or dose ( low to medium dose range ) .  ICS-induced growth suppression seems to be maximal during the first year of therapy and less pronounced in subsequent years of treatment . However , additional studies are needed to better characterise the molecule dependency of growth suppression , particularly with newer molecules ( mometasone , ciclesonide ) , to specify the respective role of molecule , daily dose , inhalation device and patient age on the effect size of ICS , and to define the growth suppression effect of ICS treatment over a period of several years in children with persistent asthma . PLAIN LANGUAGE SUMMARY Do inhaled corticosteroids reduce growth in children with persistent asthma ? Review question : We review ed the evidence on whether inhaled corticosteroids ( ICS ) could affect growth in children with persistent asthma , that is , a more severe asthma that requires regular use of medications for control of symptoms . BACKGROUND Treatment guidelines for asthma recommend ICS as first-line therapy for children with persistent asthma . Although ICS treatment is generally considered safe in children , parents and physicians always remain concerned about the potential negative effect of ICS on growth . Search date : We search ed trials published until January 2014 . Study characteristics : We included in this review trials comparing daily use of corticosteroids , delivered by any type of inhalation device for at least three months , versus placebo or non-steroidal drugs in children up to 18 years of age with persistent asthma . KEY RESULTS Twenty-five trials involving 8471 children with mild to moderate persistent asthma ( 5128 treated with ICS and 3343 treated with placebo or non-steroidal drugs )  were included in this review . Eighty percent of these trials were conducted in more than two different centres and were called multi-centre studies ; five were international multi-centre studies conducted in high-income and low-income countries across Africa , Asia-Pacifica , Europe and the Americas . Sixty-eight percent were financially supported by pharmaceutical companies . Meta- analysis ( a statistical technique that combines the results of several studies and provides a high level of evidence ) suggests that children treated daily with ICS  may grow approximately half a centimeter per year less than those not treated with these medications during the first year of treatment . The magnitude of ICS-related  growth reduction may depend on the type of drug . Growth reduction seems to be maximal during the first year of therapy and less pronounced in subsequent years of treatment . Evidence provided by this review allows us to conclude that daily use of ICS can cause a small reduction in height in children up to 18 years of age with persistent asthma ; this effect seems minor compared with the known benefit of these medications for asthma control . QUALITY OF EVIDENCE Eleven of 25 trials did not report how they guaranteed that participants had an equal chance of receiving ICS or placebo or non-steroidal drugs . All but six trials did not report how research ers were kept unaware of the treatment assignment list . However , this method ological limitation may not significantly affect the quality of evidence because the results remained almost unchanged when we excluded these trials from the analysis BACKGROUND : Although the need for corticosteroids in acute severe asthma is well established the appropriate dose is not known . METHODS : The response to intravenous hydrocortisone 50 mg ( low dose ) , 100 mg ( medium dose ) , and 500 mg ( high dose ) , administered every six hours for 48 hours and followed by oral prednisone , was compared in patients with acute asthma in a double blind r and omised study . After initial emergency treatment with bronchodilators subjects received oral theophylline or intravenous aminophylline and nebulised salbutamol four hourly . Patients were given low , medium , or high doses of intravenous hydrocortisone and then 20 , 40 , or 60 mg/day respectively of oral prednisone with a reducing regimen over the following 12 days . Beclomethasone dipropionate , 400 micrograms twice daily by metered dose inhaler , was also started . Peak expiratory flow ( PEF ) , forced expiratory volume in one second ( FEV1 ) , and visual analogue dyspnoea scores ( VAS ) were recorded daily in hospital and PEF and VAS twice daily after discharge for a total of 12 days . RESULTS : The 66 subjects ( 40 female ) who completed the study had a mean ( SD ) age of 31(14 ) years . On presentation mean ( SD ) FEV1 % predicted in the low ( n = 22 ) , medium ( n = 20 ) , and high dose ( n = 24 ) groups was 17(13 ) , 19(12 ) , and 19(11 ) and after emergency bronchodilator treatment 32(20 ) , 30(12 ) , and 36(13 ) . After 24 hours of treatment the respective post-bronchodilator FEV1 % predicted values were 62(22 ) , 62(23 ) , and 65(28 ) compared with 71(24 ) , 69(22 ) , and 71(24 ) after 48 hours . No significant difference between the groups was detected . PEF and VAS improved with treatment over the 12 days but was not influenced by steroid dose . CONCLUSIONS : Hydrocortisone 50 mg intravenously four times a day for two days followed by low dose oral prednisone is as effective in resolving acute severe asthma as 200 or 500 mg of hydrocortisone followed by higher doses of prednisone Ninety-eight children aged 1 - 15 years entered a r and omized double-blind study investigating an appropriate dose of oral prednisolone in children admitted to hospital with an acute exacerbation of asthma . None of the children had recently been treated with oral prednisolone .  Following admission , the children were r and omized to receive prednisolone 0.5 mg kg-1 , 1.0 mg kg-1 or 2.0 mg kg-1 in a single daily dose in addition to nebulized bronchodilators .  Clinical asthma scores , oxygen saturations , pulse rate , duration of admission and number of nebulizers given were compared in the three treatment groups . Thirty-five children received 0.5 mg kg-1 , 33 received 1.0 mg kg-1 and 30 received 2.0 mg kg-1 . There were no significant differences in the pattern of recovery between the three treatment groups . There were no advantages in using higher doses of prednisolone . We recommend 0.5 mg kg-1 day-1 of prednisolone as an appropriate dose for treating an acute exacerbation of asthma The purpose of this study was to determine if there is a difference in early relapse rates between patients receiving an 8-day course of 40 mg/day prednisone  and those receiving an 8-day tapering course of prednisone . Furthermore , we wished to determine if one regimen is superior to the other for minimizing adrenal suppression . This was a prospect i ve , r and omized , double blind clinical trial conducted in an urban , university-affiliated Level 1 trauma center . All asthmatic patients with exacerbation who were judged well enough for discharge home from the emergency department ( ED ) were eligible for participation . Patients with a history of chronic obstructive pulmonary disease , congestive heart failure , pneumonia , pneumothorax , or other pulmonary process , and asthmatics already using inhaled or oral steroids within 2 weeks of admission to the ED were excluded . Before treatment , a cosyntropin stimulation test was administered to all asthmatics admitted to the ED . All patients treated in the ED then received three doses of aerosolized albuterol , 60 mg of i.v . methylprednisolone , and oxygen .  FEV1 was measured before treatment , after each treatment , and 1 h after the third aerosol administration . Patients were then sent home with either an 8-day course of 40 mg/day prednisone or an 8-day tapering course of prednisone ( tapering from 40 mg to 0 mg ) . Patients were asked to return on day 12 for another cosyntropin stimulation test and pulmonary function testing and on day 21 for pulmonary function testing only . Fifteen patients participated : seven received a nontapering dose of prednisone and eight received a tapering dose of prednisone . There were no differences in the FEV1 percent predicted , the incidence of relapse , or the incidence of adrenal suppression between the two groups . In our small study , we found no difference in relapse rate between asthmatics receiving an 8-day tapering dose of prednisone and those receiving 40 mg/day prednisone upon discharge from the ED . Furthermore , no patients had evidence of adrenal suppression from either dosing regimen
BACKGROUND Asthma is a common long-term breathing condition that affects approximately 300 million people worldwide .
People with asthma may experience short-term worsening of their asthma symptoms ; these episodes are often known as ' exacerbations ' , ' flare-ups ' , ' attacks ' or ' acute asthma ' .
Oral steroids , which have a potent anti-inflammatory effect , are recommended for all but the most mild asthma exacerbations ; they should be initiated promptly .
The most often prescribed oral steroids are prednisolone and dexamethasone , but current guidelines on dosing vary between countries , and often among different guideline producers within the same country .
Despite their proven efficacy , use of steroids needs to be balanced against their potential to cause important adverse events .
Evidence is somewhat limited regarding optimal dosing of oral steroids for asthma exacerbations to maximise recovery while minimising potential side effects , which is the topic of this review .
OBJECTIVES To assess the efficacy and safety of any dose or duration of oral steroids versus any other dose or duration of oral steroids for adults and children with an asthma exacerbation .