ICPP: Three Days of Prednisolone Better than Seven for Children with Acute Asthma

NICE, FRANCE — February 19, 2002 — After an attack of acute asthma, children are often prescribed a 3-10 day course of systemic prednisolone. However, three days of treatment may provide the same benefits and reduce the dangers associated with longer steroid treatment.

Senja Kannisto and associates of the Dept. of Pediatrics at Kuopio University Hospital, Finland compared the efficacy and drawbacks of three and seven day prednisolone administration to determine which might be better for young patients. The results were presented here at the Fifth International Congress on Pediatric Pulmonology.

Forty asthmatic children aged 2.7 – 14.8 years presenting with asthma exacerbation were randomized to receive either 1.5 mg/kg/day (with a maximum of 30 mg) for three days (n=19), or the same dose for 7 days. All administrations were made as a single morning dose. "All these children were hospitalized for at least one day," said Matti Korppi, co-author and Professor of Pediatrics.

Treatment efficacy was assessed by measuring forced expiratory volume in one second (FEV1) before and after bronchodilator administration, by following asthma symptoms, and by monitoring the use of on-demand bronchodilators. This was done at the beginning of treatment, one day after treatment discontinuation and at 28 days.

Treatment safety was evaluated by low-dose ACTH tests one day after discontinuation of prednisolone.

Both groups initially showed severe respiratory obstruction, with mean FEV1 levels of 76 percent and 78 percent of those predicted in the 3- and 7-day treatment groups. However, after 4 weeks both had returned to normal (97 percent and 95 percent respectively). In baseline bronchodilation tests, both groups showed 12 percent FEV1 improvements. Initial bronchodilator responses were 11 percent and 5 percent respectively, falling to 3 percent and 4 percent respectively after 4 weeks. Asthma symptoms and the need for bronchodilators were equally well resolved with either treatment. "Both groups improved exactly the same," said Korppi.

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