Nisreen Alhumaideen MD, Alaa Alsghireen MD, *Bashar Alanakrih MD and Nusayba Alabadi MD


Background: 5–25% of patient’s relapse, needing admission for therapy of consecutive attacks. Inhaled corticosteroids are considered potent in the management of pediatric bronchial asthma. Inhaled corticosteroids vs. oral corticosteroids efficiency regarding the control of severe acute pediatric bronchial asthma is debatable. Aim: To assess the management potency of inhaled fluticasone and of oral prednisone during four hours following receiving in pediatric severe acute bronchial asthma. Methods: Our prospective, randomized and double-blind investigation included 115 patients, aged 6-14 years, of both sexes and with severe acute bronchial asthma (confirmed by a reference forced expiratory volume in one second of less than 60% of the predicted) at Queen Rania hospital, KHMC, Amman, JORDAN, during the period Jun 2021-Apr 2022. All patients were managed with bronchodilators and were administered one dose of 2 mg of inhaled fluticasone via an inhaler (Group I, n=58) or one dose of 2 mg of oral prednisone syrup per kilogram (Group II, n=57). Patients were evaluated each hour during the following 6 hours of receiving. Patients were sent home where the fluticasone group were administered 500 mcg of fluticasone twice daily by inhaler for one week and the prednisone group were administered 1 mg of oral prednisone per kilogram daily for one week. The modification in FEV1 as a percentage of the predicted from reference (time 0) to 6 hours was the primary outcome. Secondary outcomes were the modifications in the forced vital capacity (FVC) and the predicted peak expiratory flow rate as percentages of the predicted, the respiratory rate and oxygen saturation on room air. Lung-functions were performed in terms of the American Thoracic Society. The highest value was taken for investigation. These outcomes were recorded at half an hour prior to the primary nebulized dose of investigation drugs; at 0 minutes (prior to investigation drugs); at 1h, 2h, 6h and on day 8. Student's t-test was used for continuous parameters and Wilcoxon rank-sum test was used for skewed parameters. Results: The average reference forced expiratory volume in one second (percentage of predicted) was 44.3±10.2 in group I and 41.7±7.6 in group II. Eighteen patients (31.03%) managed with inhaled fluticasone and 6 patients (10.5%) managed with oral prednisone (P<0.02) were admitted. In the prednisone group, 15 of the 57 patients (26.3%) experienced an excellent reaction and 6 of 58 patients (10.3%) experienced an excellent reaction in the inhaled fluticasone. Conclusions: Patients with severe acute bronchial asthma must be managed with oral prednisone and not with inhaled fluticasone.

Keywords: Bronchial asthma: severe; agents: oral prednisone, inhaled fluticasone; forced expiratory volume in one second.

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