Inhaled Corticosteroids May Be Superior to Systemic Corticosteroids in Children with Moderate-to-Severe Acute Asthma

The objective of this study was to assess the efficacy of inhaled triamcinalone as compared to oral prednisone or intravenous methylprednisolone in the treatment of children with moderate-to-severe acute asthma. This prospective, randomized trial involved convenience sampling of children 6 years and older presenting to one of two pediatric emergency centers. Patients were randomized to receive inhaled, oral, or intravenous corticosteroids. Patients receiving inhaled corticosteroids (600 mcg of inhaled triamcinalone acetonide with inhaler and spacer) in the emergency center and discharged home, received 4 consecutive days of the same preparation (600 mcg TID for 1 day and 400 mcg TID for the next 3 days). Patients receiving either oral [prednisone 2 mg/kg (maximum 80 mg)] or intravenous corticosteroids [methylprednisolone 2 mg/kg (maximum 80 mg)] and discharged home received a 4-day course of the oral preparation [prednisone 1 mg/kg/day BID (maximum 40 mg/day)]. Of 135 children enrolled, 106 were discharged, 26 were hospitalized, and 3 were disqualified. There were significantly less hospitalizations and unscheduled return visits in the inhaled (7% hospitalized, 12% unscheduled return visits) as compared to the oral (22%, 42%) and intravenous (29%, 41%) groups (p = 0.02, p = 0.007). In children with a moderate-to-severe asthma exacerbation, inhaled triamcinalone reduced the rate of hospitalizations when compared to oral prednisone and intravenous methylprednisolone. In the week after discharge from the emergency center, children continuing inhaled triamcinalone had fewer unscheduled return visits than children continuing oral prednisone.