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PEDIATRICS Vol. 112 No. 2 August 2003, pp. 382-397

SPECIAL ARTICLE

Treating Exacerbations of Asthma in Children: The Role of Systemic Corticosteroids

Gary Rachelefsky, MD

From the Allergy Research Foundation, Inc, Los Angeles, California

Objective. To review the use of systemic corticosteroids to treat recurrent, acute asthma episodes in children, with a focus on the role of oral corticosteroids.

Methods. A comprehensive review of the literature was performed using the Medline database (January 1966–October 2002) and the Embase database (January 1980–August 2002).

Results. The significant findings of 17 selected, controlled clinical trials of oral corticosteroids (OCSs) for acute exacerbations of asthma in children, compared with placebo or with other formulations of corticosteroids, can be summarized as follows: 1) OCSs are effective for the outpatient treatment of acute asthma, 2) pulmonary function tests may not be the best means of assessing the efficacy of OCSs for acute asthma, 3) early administration of OCSs for acute asthma reduces hospitalizations, 4) the critical factor for a positive outcome is early administration of the corticosteroid, and 5) OCSs are preferred for the outpatient treatment of acute asthma.

Conclusions. Early treatment of acute asthma symptoms with OCSs in children with a pattern of recurrent acute asthma may decrease the severity of acute asthma episodes and reduce the likelihood of subsequent relapses. Attention should be given to identifying these children and standardizing a treatment approach based on accepted, consistent definitions of what constitutes an asthma exacerbation and recurrence. A suggested protocol is described.

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Key Words: acute asthma • asthma exacerbation • asthma therapy • childhood asthma • emergency department • steroids • systemic corticosteroids • upper respiratory tract infection • wheeze

Abbreviations: ED, emergency department • OCS, oral corticosteroid • PEF(R), peak expiratory flow (rate) • URI, upper respiratory tract infection • ICS, inhaled corticosteroid • IV, intravenous • RSV, respiratory syncytial virus

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Received for publication Jan 7, 2003; Accepted Jan 7, 2003.

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