Oral Prednisolone Dosing in Children Hospitalized with Asthma

RationaleWe sought to determine whether standard dose prednisolone is as effective as a high dose recommended for children hospitalized with asthma by EPR-2 national guidelines.MethodsIn this randomized, double-blind, controlled trial, children aged 2-18 years admitted for asthma were stratified by severity and randomized to receive either 1 mg/kg of prednisolone every 6 hours (high), or 1 mg/kg of prednisolone every 12 hours alternating with placebo (standard), for the first 48 hours of hospitalization. All other care was in accordance with a standardized asthma treatment protocol. The primary outcome was time from steroid load until the second albuterol treatment spaced to every 4 hours (q4h). Secondary outcomes included time to actual discharge, clinical measures, and adverse events following discharge. Outcomes were compared by survival analysis and chi-square test.Results152 patients were enrolled and groups were similar at baseline. Study outcomes did not differ between groups for median time from prednisolone load to second q4 treatment (high dose 35 vs. standard 33 hours, logrank test p > 0.8) or time to actual discharge (high 44 vs. standard 35 hours, p = 0.4). No patients required re-hospitalization, and two from each group required a repeat course of steroids. Side effects were mild and similar between groups except for hyperactivity and aggressive behavior, which were reported with significantly higher frequency in the standard dose group.ConclusionsStandard dose prednisolone was no less effective than high dose in treating children hospitalized for asthma as measured by time to discharge criteria in a standardized treatment protocol. RationaleWe sought to determine whether standard dose prednisolone is as effective as a high dose recommended for children hospitalized with asthma by EPR-2 national guidelines. We sought to determine whether standard dose prednisolone is as effective as a high dose recommended for children hospitalized with asthma by EPR-2 national guidelines. MethodsIn this randomized, double-blind, controlled trial, children aged 2-18 years admitted for asthma were stratified by severity and randomized to receive either 1 mg/kg of prednisolone every 6 hours (high), or 1 mg/kg of prednisolone every 12 hours alternating with placebo (standard), for the first 48 hours of hospitalization. All other care was in accordance with a standardized asthma treatment protocol. The primary outcome was time from steroid load until the second albuterol treatment spaced to every 4 hours (q4h). Secondary outcomes included time to actual discharge, clinical measures, and adverse events following discharge. Outcomes were compared by survival analysis and chi-square test. In this randomized, double-blind, controlled trial, children aged 2-18 years admitted for asthma were stratified by severity and randomized to receive either 1 mg/kg of prednisolone every 6 hours (high), or 1 mg/kg of prednisolone every 12 hours alternating with placebo (standard), for the first 48 hours of hospitalization. All other care was in accordance with a standardized asthma treatment protocol. The primary outcome was time from steroid load until the second albuterol treatment spaced to every 4 hours (q4h). Secondary outcomes included time to actual discharge, clinical measures, and adverse events following discharge. Outcomes were compared by survival analysis and chi-square test. Results152 patients were enrolled and groups were similar at baseline. Study outcomes did not differ between groups for median time from prednisolone load to second q4 treatment (high dose 35 vs. standard 33 hours, logrank test p > 0.8) or time to actual discharge (high 44 vs. standard 35 hours, p = 0.4). No patients required re-hospitalization, and two from each group required a repeat course of steroids. Side effects were mild and similar between groups except for hyperactivity and aggressive behavior, which were reported with significantly higher frequency in the standard dose group. 152 patients were enrolled and groups were similar at baseline. Study outcomes did not differ between groups for median time from prednisolone load to second q4 treatment (high dose 35 vs. standard 33 hours, logrank test p > 0.8) or time to actual discharge (high 44 vs. standard 35 hours, p = 0.4). No patients required re-hospitalization, and two from each group required a repeat course of steroids. Side effects were mild and similar between groups except for hyperactivity and aggressive behavior, which were reported with significantly higher frequency in the standard dose group. ConclusionsStandard dose prednisolone was no less effective than high dose in treating children hospitalized for asthma as measured by time to discharge criteria in a standardized treatment protocol. Standard dose prednisolone was no less effective than high dose in treating children hospitalized for asthma as measured by time to discharge criteria in a standardized treatment protocol.