Efficacy of Inhaled Compared to Oral Corticosteroids for Acute Asthma Exacerbation in Children

   According to a study presented at the annual meeting of the American Academy of Allergy, Asthma and Immunology in New Orleans, inhaled corticosteroids are more effective than systemic corticosteroids for the treatment of acute pediatric asthma exacerbations in the ED setting.

   They performed a meta-analysis of randomized clinical trials published from 1986 to 2009 involving children (aged six months to 18 years) presenting with acute asthma exacerbation to the ED who were assigned to at least one of the randomization arms of corticosteroid treatment or placebo. They identified the relative efficacy of systemic and inhaled corticosteroids in the treatment of acute asthma exacerbation using the hospitalization rate as the primary outcome.

   The pooled odds ratio (OR) and number needed to treat (NNT), with 95% confidence interval [CI], were calculated. (Randomized clinical trials that compared inhaled corticosteroids plus systemic corticosteroids with systemic corticosteroids alone were not included.)

   In the 10 identified RCTs, 388 patients were treated with inhaled corticosteroids, 337 with systemic corticosteroids, and 298 with placebo. Irrespective of the route of delivery (inhaled corticosteroids  or systemic corticosteroids), the hospitalization rate was higher in children randomized to the placebo group (33.8%, [P<0.01). The likelihood for hospitalization in those who received inhaled corticosteroids was significantly lower as compared with systemic corticosteroids treatment (13.7% vs 20.8%, OR 0.60, 95% CI, to 0.41 to 0.88). The NNT to prevent one hospitalization of a child with acute asthma exacerbation was five (95% CI, 4 to 8) for inhaled corticosteroids and eight (95% CI, 5 to 19) for systemic corticosteroids.

   In the ED setting, inhaled corticosteroids "are beneficial for the treatment of acute pediatric asthma exacerbations," the researchers concluded.