Chest
Volume 122, Issue 2, August 2002, Pages 624-628
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Clinical Investigations
STEROIDS
Adverse Behavioral Effects of Treatment for Acute Exacerbation of Asthma in Children: A Comparison of Two Doses of Oral Steroids

https://doi.org/10.1378/chest.122.2.624Get rights and content

Objective

To determine the relative adverse symptomatic effects and benefits of therapy with oral corticosteroids at doses of 2 mg/kg vs 1 mg/kg daily in children with acute exacerbations of asthma.

Methods

Using a questionnaire that addressed symptoms, we conducted a prospective study of the adverse effects and benefits of therapy with prednisone or prednisolone at two dose levels in 86 children who were 2 to 16 years of age with mild persistent asthma during an acute exacerbation and were unresponsive to therapy with inhaled steroids and β-adrenergic agents. Parents and physicians were blinded to the dose level. Children were assigned to either of the two doses by random allocation. Behavioral side effects were assessed via a questionnaire administered by a physician. Benefits were measured by the resolution of asthma symptoms (cough, shortness of breath, and wheeze) at the completion of the treatment with oral steroids.

Results

Behavioral side effects, particularly anxiety (p < 0.02) and aggressive behavior (p < 0.002), were twice as common in patients receiving a dose of 2 mg/kg/d. Benefits were comparable in the two groups. The number needed to harm (ie, the number of patients receiving experimental treatment that would lead to one additional person being harmed vs patients receiving standard treatment) was 6.1 for anxiety, 8.6 for hyperactivity, and 4.8 for aggressive behavior.

Conclusions

Because the adverse side effects were greater at the higher dose but the benefits were comparable, we recommend using an oral corticosteroid dose of 1 mg/kg daily for children with mild persistent asthma who present with an acute exacerbation of asthma.

Section snippets

Materials and Methods

The Institutional Review Committee of Bridgeport Hospital approved the study. Patients presenting at the hospital or an outpatient asthma center with persistent asthma were identified. Informed consent was obtained. Patients aged 2 to 18 years were eligible for inclusion if at baseline they had mild persistent asthma based on National Institutes of Health guidelines (cough, shortness of breath, or wheeze more than twice a week but less than once a day and similar nighttime symptoms more than

Results

Of 92 families asked to participate, 88 were enrolled. The age, sex, and ethnic distribution in the two groups were comparable. Patients in both groups received three doses of albuterol, 2.5 mg, in a 1-h period. None of the patients needed to be admitted to the hospital. Oral prednisone or prednisolone was prescribed at the discretion of the physician, plus albuterol MDI, 2 puffs q6h for 5 days. As the maximum dose was 60 mg, one child in group 2 did not receive the 2 mg/kg/d dose. All the

Discussion

While the two dose regimens did not produce different benefits in terms of asthma symptoms, behavioral side effects, particularly aggressive behavior and anxiety, were twice as common in patients receiving the 2 mg/kg daily dose. Parents reported that these behavioral symptoms resolved after the discontinuation of oral steroid therapy.

We considered whether reporting bias by the parents could account for the observed difference in behavior. The parents did not know the study outcome variables

ACKNOWLEDGMENT

We would like to acknowledge Yaw Adgepong, MD, for his kind help in doing the statistical analysis in this study.

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