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ARTICLES:
Flory L. Nkoy, Bernhard A. Fassl, Tamara D. Simon, Bryan L. Stone, Rajendu Srivastava, Per H. Gesteland, Gena M. Fletcher, and Christopher G. Maloney
Quality of Care for Children Hospitalized With Asthma
Pediatrics 2008; 122: 1055-1063 [Abstract] [Full text] [PDF]
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[Read eLetters] Intravenous Steroids are Sometimes Appropriate in Inpatient Asthma Management
Brandon M. Smith, MD   (18 November 2008)

Intravenous Steroids are Sometimes Appropriate in Inpatient Asthma Management 18 November 2008
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Brandon M. Smith, MD,
Pediatric Hospitalist
Division of Pediatric Hospital Medicine, Department of Pediatrics, Penn State College of Medicine

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Re: Intravenous Steroids are Sometimes Appropriate in Inpatient Asthma Management

bsmith11{at}hmc.psu.edu Brandon M. Smith, MD

To the editor.-

As a pediatric hospitalist, I read the article by Nkoy, et al. entitled “Quality of Care for Children Hospitalized With Asthma”1 with great interest. The authors should be commended for such a systematic approach to developing process-based quality measures for inpatient asthma care. I am concerned, however, by the choice to include “Use of oral (not intravenous) systemic corticosteroid therapy” as one of the quality measures. The authors cite a Cochrane Database of Systematic Reviews article to support the inclusion of this measure, but the most current Cochrane review on this subject states that “no specific conclusions can be drawn about the comparative efficacy of the two routes of systemic corticosteroid administration.”2 Even if we assume that the two routes are equivalent in terms of outcome, certain circumstances may still call for the use of intravenous steroids. These circumstances include intolerance of oral medication (e.g. emesis) or need to maintain an empty stomach (e.g. impending respiratory failure). As a practicing pediatric hospitalist, it would concern me if the quality of care I provided was judged to be suboptimal because I prescribed intravenous steroids under those circumstances.

1. Nkoy F, Fassl B, Simon T, et al. Quality of Care for Children Hospitalized With Asthma. Pediatrics. 2008;122 (5):1055 –1063

2. Smith M, Iqbal SMSI, Rowe BH, N’Diaye T. Corticosteroids for hospitalised children with acute asthma. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD002886. DOI: 10.1002/14651858.CD002886.

Conflict of Interest:

None declared