A pilot study of steroid therapy after emergency department treatment of acute asthma: is a taper needed?

The purpose of this study was to determine if there is a difference in early relapse rates between patients receiving an 8-day course of 40 mg/day prednisone and those receiving an 8-day tapering course of prednisone. Furthermore, we wished to determine if one regimen is superior to the other for minimizing adrenal suppression. This was a prospective, randomized, double blind clinical trial conducted in an urban, university-affiliated Level 1 trauma center. All asthmatic patients with exacerbation who were judged well enough for discharge home from the emergency department (ED) were eligible for participation. Patients with a history of chronic obstructive pulmonary disease, congestive heart failure, pneumonia, pneumothorax, or other pulmonary process, and asthmatics already using inhaled or oral steroids within 2 weeks of admission to the ED were excluded. Before treatment, a cosyntropin stimulation test was administered to all asthmatics admitted to the ED. All patients treated in the ED then received three doses of aerosolized albuterol, 60 mg of i.v. methylprednisolone, and oxygen. FEV1 was measured before treatment, after each treatment, and 1 h after the third aerosol administration. Patients were then sent home with either an 8-day course of 40 mg/day prednisone or an 8-day tapering course of prednisone (tapering from 40 mg to 0 mg). Patients were asked to return on day 12 for another cosyntropin stimulation test and pulmonary function testing and on day 21 for pulmonary function testing only. Fifteen patients participated: seven received a nontapering dose of prednisone and eight received a tapering dose of prednisone. There were no differences in the FEV1 percent predicted, the incidence of relapse, or the incidence of adrenal suppression between the two groups. In our small study, we found no difference in relapse rate between asthmatics receiving an 8-day tapering dose of prednisone and those receiving 40 mg/day prednisone upon discharge from the ED. Furthermore, no patients had evidence of adrenal suppression from either dosing regimen.

RCT Entities:   Population Interventions Outcomes