A comparison of Oral and Inhalant Corticosteroids in Treatment of Mild to Moderate Asthma Exacerbation in Children

Nemat Bilan, Lida Saboktakin, Masoumeh Ghasempour


Introduction: Oral corticosteroids are the main treatment in asthma exacerbation. It has been reported that inhaled corticosteroids can be used instead of oral corticosteroids in asthma exacerbation. We aimed to evaluate the efficacy of inhaled fluticasone and oral prednisolone in children with mild to moderate asthma exacerbation. 

Materials and Methods: In this randomized clinical trial, 60 children with mild-to-moderate acute asthma exacerbation visiting emergency department were randomly assigned to receive oral prednisolone (2 mg/kg) or fluticasone spray (2 puffs every 12 hours, each puff contains 250 microgram fluticasone) using an spacer for one week. The first dose of the treatment was given in the emergency department.  Children were followed for seven days and signs and symptoms of exacerbation, as well as spirometry findings were evaluated.

Results: On the days 1 and 3, symptoms including cough, sputum and need for salbutamol during day was more improved in oral prednisolone and symptoms at night was more improved in inhaled fluticasone. Patients were almost symptom free on the seventh day. Forced expiratory volume in 1 second, forced vital capacity and forced expiratory flow rate on the seventh day were significantly better with inhaled fluticasone compared to oral prednisolone.

Conclusion: Both inhaled fluticasone and oral prednisolone improved symptoms during a week after exacerbation; however, better respiratory function in children treated with inhaled fluticasone is indicative of its further efficacy compared to oral prednisolone. Considering the low systemic effects of inhaled fluticasone, this treatment seems to be more appropriate in treatment of mild to moderate exacerbations.


Keywords: Asthma exacerbation; Inhaled fluticasone; Prednisolone

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