Oral steroids are as effective as intravenous steroids in acute severe asthma
Date First Published:
March 1, 2000
Last Updated:
April 11, 2001
Report by:
Martin Smith, Specialist Registrar (Manchester Royal Infirmary)
Search checked by:
Terry Gilpin, Manchester Royal Infirmary
Three-Part Question:
In [patients with acute severe asthma] are [oral prednisolone as good as intravenous hydrocortisone] in [improving respiratory symptoms]?
Clinical Scenario:
A 24 year old male with asthma presents to the Emergency Department with severe wheeze and dyspnoea. While nebulised bronchodilators are being administered you wonder whether it is better to prescribe oral or intravenous steroids.
Search Strategy:
Medline 1966-3/99 using the OVID interface.
Search Details:
{exp asthma OR asthma.mp} AND ([{exp steroids OR steroid$.mp OR exp prednisolone OR prednisolone.mp} AND {exp administration, oral OR oral.mp}] AND [{exp steroids OR steroid$.mp OR hydrocortisone.mp} AND {exp infusions,intravenous OR exp injections, intravenous OR intravenous.mp}]) LIMIT to human and english language.
Outcome:
66 papers found of which 60 were irrelevant to the study question and one of insufficient quality for inclusion. All but one paper was included in a metaanlysis.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Effectiveness of steroid therapy in acute exacerbations of asthma: a meta-analysis. Rowe BH, Keller JL, Oxman AD et al. 1992 Canada | 30 PRCTs of which * addressed the issue of oral vs intravenous therapy | Metaanalysis | Effectiveness in acute exacerbations | no significant difference | |
| Intravenous versus oral corticosteroids in the management of acute asthma in children. Barnett PL, Caputo GL, Baskin M et al. 1997 USA | 49 children with moderate to severe asthma. 2 mg/kg oral methylprednisolone (23) vs 2 mg/kg intravenous prednisolone (26) |
PRCT | Respiratory rate, FEV1, oxygen saturation | no significant difference | Follow up only 4 h. No power study |
| Admission rate | no significant difference |
Author Commentary:
There is no good evidence for the superiority of either route of administration but all studies to date have been on very small numbers of patients. These studies may well have been of insufficient power to detect real differences (type II error).
Bottom Line:
Steroids should continue to be given intravenously if intravenous access is necessary for other drugs or if the patient cannot take drugs by mouth. In other cases oral administration is acceptable.
References:
- Rowe BH, Keller JL, Oxman AD et al.. Effectiveness of steroid therapy in acute exacerbations of asthma: a meta-analysis.
- Barnett PL, Caputo GL, Baskin M et al.. Intravenous versus oral corticosteroids in the management of acute asthma in children.