Oral versus intravenous corticosteroids in adults hospitalised with acute asthma

Abstract Background Systemic corticosteroids are routinely used in the management of acute asthma, however the optimum route of administration for patients requiring hospitalisation is unclear. Intravenous (IV) corticosteroids are used in practice, but they may not offer any advantage over oral corticosteroids. Aim To compare the efficacy of oral and IV administration of corticosteroids in the treatment of adults hospitalised with acute asthma. Method Adults admitted to hospital for treatment of acute asthma were randomised to receive oral prednisolone 100 mg once daily or hydrocortisone 100 mg IV 6 hourly for 72 h following admission. All patients concurrently received inhaled corticosteroids and bronchodilators. Improvements in peak expiratory flow rate (PEF) from baseline were compared for 72 h. Results Forty-seven patients were randomized, 30 females, 17 males. Twenty-four received oral prednisolone and 23 received IV hydrocortisone. At baseline the oral and IV groups were similar (mean, SD) in age (38.3, 12.8 vs 37.3, 12.9, P =0.80) and initial percent predicted (PP) PEF (61, 16.7 vs 69, 13.0, P =0.11). After 72 h both groups had similar improvements in PEF (27%, 26 vs 27%, 19, P =0.96). Conclusion Corticosteroids administered orally and IV had similar efficacy in the treatment of adults hospitalised with acute asthma.