scholarly journals A Randomised Controlled Trial of High Dose, Inhaled Budesonide Versus Oral Prednisone in Patients Discharged from the Emergency Department following an Acute Asthma Exacerbation

2000 ◽  
Vol 7 (1) ◽  
pp. 61-67 ◽  
Author(s):  
J Mark FitzGerald ◽  
David Shragge ◽  
Jennifer Haddon ◽  
Barbara Jennings ◽  
Joanna Lee M Math ◽  
...  
Keyword(s):  
Emergency Department ◽  
Relapse Rate ◽  
Acute Asthma ◽  
Controlled Trial ◽  
Oral Prednisone ◽  
Final Visit ◽  
High Dose ◽  
Forced Expiration ◽  
Double Blind

OBJECTIVE:Prednisone (PRED) is recommended at discharge to reduce the relapse rate following emergency treatment for an asthmatic attack. However, PRED has systemic side effects. Inhaled anti-inflammatory medications, such as budesonide (BUD), are well tolerated. This study was designed to compare the effectiveness of PRED and BUD on relapse rate.DESIGN:A prospective, randomized, double-blind, double dummy, parallel group design.SETTING:Tertiary referral emergency departments.POPULATION STUDIED:One hundred and eighty-five patients with acute asthma who received standard treatment with bronchodilators and systemic glucocorticosteroids in the emergency department, had a forced expiration volume in 1 s (FEV1) greater than 50% predicted and who were deemed well enough to be discharged from the emergency department.INTERVENTION:Patients were randomized to receive either BUD Turbuhaler 600 µg qid or PRED 40 mg in the morning for seven to 10 days. At discharge and final visit, symptoms, medication use, FEV1,peak expiratory flow (PEF) and quality of life (QoL) were assessed. Relapse rate to the emergency department during the follow-up was determined by a yes and/or no questionnaire.MAIN RESULTS:The PRED (n=85) and BUD (n=90) treatment groups were comparable at baseline (emergency department discharge) for age (mean ± SD; 27.6±8.5 years and 29.2±8.7 years) and prebronchodilator FEV1(1.77±0.79 L and 1.75±0.78 L), respectively. BUD was at least as effective as PRED in preventing a relapse to the hospital; relapse rate was 10 (11.8%) during PRED treatment and nine (10.0%) for BUD treatment (95% CI PRED-BUD, -7.5% to 11.0%). Improvements in FEV1, asthma symptoms, PEF and QoL were not significantly different between treatments.CONCLUSIONS:In  patients whose acute asthma has been stabilized in the emergency department, high dose BUD may be an alternate to PRED as a follow-up treatment.

Controlled Trial of Oral Prednisone in the Emergency Department Treatment of Children With Acute Asthma

PEDIATRICS ◽  
1993 ◽  
Vol 92 (4) ◽  
pp. 513-518 ◽  
Author(s):  
Richard J. Scarfone ◽  
Susan M. Fuchs ◽  
Alan L. Nager ◽  
Steven A. Shane
Keyword(s):  
Emergency Department ◽  
Placebo Group ◽  
Acute Asthma ◽  
Controlled Trial ◽  
Oral Prednisone ◽  
Agonist Therapy ◽  
Double Blind ◽  
Oral Corticosteroids ◽  
Emergency Department Patients ◽  
Β2 Agonist

Background. Recent studies have shown that the use of parenteral corticosteroids in the emergency department decreases the hospitalization rate for patients with acute asthma. We studied the efficacy of oral corticosteroids in the emergency department treatment of moderately ill children with acute asthma. Methods. Emergency department patients aged 1 through 17 years whose chief complaint was acute asthma were assigned a pulmonary index, based on clinical evaluation. Those with a moderate exacerbation (pulmonary index = 9 through 13) received either 2 mg/kg of oral prednisone or placebo in a randomized, double-blind fashion. Patients in each group were then treated with an identical regimen of frequent aerosolized albuterol, for up to a maximum of 4 hours. Results. Seventy-five patients were assessed. Overall, 11 (31%) of 36 in the prednisone group required hospitalization compared with 19 (49%) of 39 in the placebo group (P = .10). Among the sickest patients (initial pulmonary index > 10), 7 (32%) of 22 prednisone-treated patients required hospitalization compared with 13 (72%) of 18 placebo-treated patients (P < .05). Among patients who had a suboptimal response to initial β2-agonist therapy and who therefore would have been hospitalized had treatment been restricted to 2 hours, 9 (45%) of 20 in the prednisone group ultimately required hospitalization when duration of care was extended 2 additional hours compared with 15 (83%) of 18 in the placebo group (P < .05). In addition, prednisone-treated patients had a significantly greater improvement in median pulmonary index (5.0 vs 3.0, P < .001). Conclusions. These data demonstrate that oral prednisone, within 4 hours of its administration, reduced the need for hospitalization among a subset of children treated in the emergency department for acute asthma.

scholarly journals Comparison of Intramuscular Betamethasone and Oral Pprednisone in the Prevention of Relapse of Acute Asthma

2001 ◽  
Vol 8 (3) ◽  
pp. 147-152 ◽  
Author(s):  
John S Chan ◽  
Robert L Cowie ◽  
Gerald C Lazarenka ◽  
Cinde Little ◽  
Sandra Scott ◽  
...  
Keyword(s):  
Relapse Rate ◽  
Intramuscular Injection ◽  
Inhaled Corticosteroids ◽  
Acute Asthma ◽  
Oral Prednisone ◽  
Double Blind ◽  
Intention To Treat ◽  
Single Intramuscular Injection ◽  
Acute Exacerbations ◽  
Long Acting

OBJECTIVE: To compare the relapse rate after a single intramuscular injection of a long acting corticosteroid, betamethasone, with oral prednisone in patients discharged from the emergency department (ED) for acute exacerbations of asthma.PATIENTS AND METHODS: Patients with acute exacerbations of asthma who were suitable for discharge from the ED were enrolled in a double-blind, randomized, placebo controlled pilot study. At discharge, patients were randomly assigned to receive either intramuscular betamethasone 12 mg and placebo capsules, or a placebo intramuscular injection and prednisone 50 mg daily for seven days. At days 7 and 21, patients were contacted by telephone to determine relapse. Relapse was defined as an unscheduled visit to a physician for treatment of continuing or worsening symptoms of asthma.RESULTS: One hundred and seventy-one patients were enrolled, of whom 87 were randomly assigned to the betamethasone group and 84 to the prednisone group. Baseline char- acteristics were matched evenly between the groups, with the exception of asthma duration (15.5 versus 21.2 years, respectively) and use of inhaled corticosteroids (46% versus 64.3% respectively) (P<0.05). Using intention-to-treat analysis, the relapse rates for betamethasone and prednisone at day 7 were 14.9% (13 of 87 patients) and 25% (21 of 84 patients), respectively (P=0.1), and at day 21, the rates were 36.8% (32 of 87 patients) and 31% (26 of 84 patients), respectively (P=0.4). There were no differences in symptom score, peak flows and adverse effects between the two groups at days 7 and 21.CONCLUSIONS: A single dose of intramuscular betamethasone 12 mg was safe and as efficacious as prednisone in preventing the relapse of acute asthma. There was a trend toward a reduced relapse rate at seven days. In select ED patients discharged for acute asthma, intramuscular betamethasone may be an effective alternative to prednisone.

CONTROLLED TRIAL OF ORAL PREDNISONE IN THE EMERGENCY DEPARTMENT TREATMENT OF CHILDREN WITH ACUTE ASTHMA

PEDIATRICS ◽  
1995 ◽  
Vol 96 (2) ◽  
pp. 401-402
Author(s):  
Brett Kettelhut ◽  
Napoleon Lee ◽  
Roger H. Kobayashi
Keyword(s):  
Emergency Department ◽  
Acute Asthma ◽  
Controlled Trial ◽  
Oral Prednisone ◽  
Hospitalization Rate ◽  
Emergency Department Setting

Initiation of oral prednisone in an emergency department setting reduced the hospitalization rate in a subset of children.

Randomized Controlled Trial of Emergency Department Interventions To Improve Primary Care Follow-up for Patients With Acute Asthma

CHEST Journal ◽  
2006 ◽  
Vol 129 (2) ◽  
pp. 257-265 ◽  
Author(s):  
Jill M. Baren ◽  
Edwin D. Boudreaux ◽  
Barry E. Brenner ◽  
Rita K. Cydulka ◽  
Brian H. Rowe ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Randomized Controlled Trial ◽  
Acute Asthma ◽  
Controlled Trial ◽  
Randomized Controlled
Sign in / Sign up

Export Citation Format

Share Document