Asthma: acute exacerbation: oral steroids were as effective as intravenous steroids.

Clinical bottom line (level 1b)

  1. Oral corticosteroids were statistically, though not clinically, more effective than iv corticosteroids at improving PEFR, but not at lengthening hospital stay.
  2. There was no clear difference in the number of patients developing respiratory failure.
Ratto et al: Journal of the American Medical Association 1988; 260: 527-529
Expires November 2002

The study

Unblinded concealed randomised trial without intention-to-treat
Setting: pulmonary medicine service, university hospital, USA

77 patients (aged range 18 to 64 years; mean 53, 76% female) admitted with acute asthma exacerbation and PEFR < 50% predicted (mean 26%)

Excluded if
  • history of chronic bronchitis or emphysema
  • aged <18 or >65
  • > 10 pack-year smoking
  • in-hospital steroid therapy >1 month


    • Control Group: (n = 37, 34 analysed): 160 or 320 mg/day of oral methylprednisolone
    Experimental Group: (n = 40, 36 analysed): 500 or 1000 mg/day of iv methylprednisolone
    All patients had inhaled beta-agonists and iv aminophylline as required.
    91% followed for 72 hours or until discharge

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    respiratory failure 72 hours 2
    (5.00%)    		 3
    (8.11%)    		 -62%
    (-817% to 71%)    		 -3.11%
    (-14.2% to 7.98%)    		 -32
    (NNT = 13 to infinity;
    NNH = 7 to infinity)

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    PEFR after 24 hours 68%
    (7)     		62%
    (4)     		6%
    (3% to 9%)
    duration of hospital stay (days) 3.3
    (0.2)     		3.6
    (0.2)     		0.3
    (0.2 to 0.4)

    Comments

    1. Patients were not excluded if they had been on oral prednisone at home.
    2. There was no difference between the high and medium dose groups, and only an analysis of IV vs PO is presented.

    Citation

    1. Ratto D, Alfaro C, Sipsey J, et al: are intravenous corticosteroids required in status asthmaticus?. Journal of the American Medical Association 1988; 260: 527-529
    Search Terms: acute asthma in Cochrane and Best Evidence
    Contributor: Benny Wong and Chris Ball, November 2000
    Reviewer: Mitsuhiro Kamei

    Clinical Question.
    Patient acute asthma exacerbation
    Intervention or Exposure iv corticosteroids
    Comparison oral corticosteroids
    Outcome PEFR, hospital stay and respiratory failure