A comparison of ‘abruptly stopping’ with ‘tailing off’ oral corticosteroids in acute asthma

Abstract

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 randomized 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.

A perspective on systemic corticosteroid therapy in severe bronchial asthma in adults

“…In a study of 35 patients admitted with acute asthma and treated with oral prednisolone 40 mg daily until full recovery (stable PEF within 15% of their previous best PEF or predicted PEF over 48 hours). 70 The patients were randomized to a 14-day taper dose of prednisolone (5 mg every other day) or placebo on discharge. 70 The pulmonary function obtained at 14 and 28 days (the mean over 7-14 days and 21-28 days in the case of PEF) were compared with baseline value on discharge.…”

Guideline for the management of acute asthma in children: 2013 update

“…[6,25] It is unnecessary to taper the steroid dose unless it is used for longer than 14 days. [26,27] Intravenous steroids (which include hydrocortisone, methylprednisolone and dexamethasone), should be reserved for children with life-threatening asthma or those who cannot tolerate oral CS.…”

Exacerbations of Asthma and Chronic Obstructive Pulmonary Disease (COPD): Focus on Virus Induced Exacerbations

“…As in the case of 2 -agonists debate continues regarding the optimal route of administration, dose and dosing schedule for corticosteroids in acute asthma. Tapering of the steroid dose has no advantage over abrupt cessation [168] and the intramuscular route has no benefits over oral administration [166]. It remains unclear whether inhaled corticosteroids are as effective as systemic corticosteroids or whether there is additional benefit from using both routes of administration.…”