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Previous Volume 343:689-694 September 7, 2000 Number 10 Next

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ABSTRACT

Background Inhaled corticosteroids are effective in the treatment of children with asthma. It is uncertain how inhaled corticosteroids compare with oral corticosteroids in the management of severe acute disease.

Methods We performed a double-blind, randomized trial involving 100 children five years of age or older who had severe acute asthma (indicated by a forced expiratory volume in one second [FEV₁] that was less than 60 percent of the predicted value) and in whom the results could be evaluated. All were treated with an aggressive bronchodilator regimen and received one dose of either 2 mg of inhaled fluticasone through a metered-dose inhaler with a spacer or 2 mg of oral prednisone per kilogram of body weight. They were assessed hourly for up to four hours.

Results The mean (±SD) base-line FEV₁ as a percentage of the predicted value was 46.3±12.5 in the fluticasone group (51 subjects) and 43.9±9.9 in the prednisone group (49 subjects). The FEV₁ increased by a mean of 9.4±12.5 percentage points in the fluticasone group and by 18.9±9.8 percentage points in the prednisone group four hours after therapy (P< 0.001). None of the children in the prednisone group had a reduction in FEV₁ as a percentage of the predicted value from base line to four hours, as compared with 25 percent of those in the fluticasone group (P<0.001). Sixteen (31 percent) of the children treated with fluticasone were hospitalized, as compared with five (10 percent) of those treated with prednisone (P=0.01).

Conclusions Children with severe acute asthma should be treated with oral prednisone and not with inhaled fluticasone or a similar inhaled corticosteroid.

Source Information

From the Divisions of Emergency Medicine (S.S., R.A., O.T.) and Respiratory Medicine (J.R., M.A., G.A., G.C.) and the Research Institute (S.S., A.D., M.C.), Department of Paediatrics, Hospital for Sick Children and University of Toronto, Toronto.

Address reprint requests to Dr. Schuh at the Division of Paediatric Emergency Medicine, Hospital for Sick Children, 555 University Ave., Toronto, ON M5G 1X8, Canada, or at suzanne. schuh{at}sickkids.on.ca.

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