Prednisolone and salbutamol in the hospital treatment of acute asthma.

Abstract

The use of oral prednisolone (2 mg/kg) to treat children admitted to hospital with acute asthma was assessed in a placebo controlled study. Children were further randomised to receive either 0-15 mg/kg salbutamol every 30 minutes for the first three hours of admission, or 5 mg salbutamol every one to four hours as needed. Treatment was double blind and the assessor was unaware of the nebuliser regimen given. Children were examined before and after treatment with salbutamol on arrival and reassessed four hours after admission. Seventy children completed the study. Seventeen (46%) of 37 children receiving prednisolone and six (9%) of 33 receiving placebo were fit for discharge after four hours of treatment. There was no significant difference between the two nebuliser regimens. Clinical parameters indicative of asthma severity were improved in all groups. Between group comparisons at reassessment showed higher peak flows in those receiving prednisolone and nebulisers every 30 minutes but differences were not significant for other parameters. Objective parameters indicating steroid efficacy over placebo were minimal. Despite this, those receiving prednisolone were more readily identifiable as being fit for discharge within four hours of treatment.

Clinical pathway improves pediatrics asthma management in the emergency department and reduces admissions

“…[2] In addition, the original randomized controlled trials on the use of corticosteroids in asthma exacerbation included patients less than 2 years of age. [9, 10, 12] Young children are at high risk for severe exacerbations,[2] have the highest rate of ED asthma visits,[31] and are most likely to experience delayed corticosteroid treatment. [22] In our prior study, conducted between 2006 and 2011, age less than 2 years was associated with delay to corticosteroids.…”

“…[7–12] In the original randomized controlled trials of efficacy, corticosteroids were administered within one hour of ED arrival. [6, 7] Several recent studies have confirmed that timely corticosteroid administration is associated with reduced odds of admission [13–15] and that every 30-minute delay in corticosteroid administration is associated with a nearly 20% increased odds of admission.…”

Wheezing as the sole clinical manifestation of cor triatriatum

“…[6][7][8] Even when the specific trigger is unknown, standard treatment of wheezing usually includes nebulization of a ␤ 2 -agonist and administration of systemic or inhaled corticosteroids. [9][10][11][12][13][14] When the specific cause is known to be environmental, its avoidance is obviously recommended. [6][7][8][15][16][17] In patients who do not respond to standard therapy, continued use of anti-asthmatic pharmacological agents can cause significant morbidity and even death.…”

Assessment and Treatment of Acute Asthma in Children

“…35,36 The clinical effects of corticosteroids occur at 1 to 3 hours and maximal effects at 4 to 8 hours. Intervention with CS incorporated into the early stages of emergency department treatment, in most studies, [37][38][39][40] though not all, 41,42 led to reduced hospital admissions.…”