5/5/03 Behavioral symptoms linked to steroid doseSummaryA common recommendation for the corticosteroid (CS) treatment of acute asthma flares in children is an initial dose of 1-2 mg/kg/day. But is a 2mg/kg dose really required? Shannon and Kayane of the Harvard Medical School in Boston, MA carried out a study in 86 children (age 2-16 years) with mild asthma treated with inhaled corticosteroid therapy who then had acute exacerbations of their asthma. They were randomized to receive either 1) 1 mg prednisone/kg/day (Group #1) or b) 2 mg prednisone/kg/day (Group #2) in a 5 day course of treatment. At the end of 5 days, parents of the patients answered a telephone questionnaire. According to these responses, all patients in Group #1 and all but one patient in Group #2 had complete resolution of symptoms, not significantly different. However, anxiety was reported more commonly in Group #2 children (9 of 43 vs one of 43 in Group #1). Aggressive behavior was also seen more in Group #2 (9 of 43 vs 0 of 43). The authors commented that behavioral abnormalities previously observed in children (particularly adolescents) receiving CS for acute asthma flares had formerly been attributed to effects of concomitant frequent inhGroups #1 and #2 in this study. The authors concluded that treatment with a dose of prednisone 2 mg/kg is not more effective than a dose of 1 mg/kg/day in acute asthma flares and is associated with significantly more common behavioral abnormalities. Reference - Chest 2002;122:624-28 Editor's Comments The CS doses used in the treatment of acute asthma appear to have been previously chosen rather empirically in early studies. When these were found to be effective, apparently there were few, if any, controlled studies to determine what the minimum effective CS dose would be. This study suggests that 1mg/kg/day of prednisone is as effective as a dose twice as great with none of the behavioral abnormalities associated with use of larger CS doses. However, the behavioral abnormalities noted in this study appear to be relatively transient though still a potential problem in school and social interactions. The authors thought that their findings in a study population of mild asthmatics with acute flares might also be applicable to those with more severe chronic asthma. However, further investigation must be carried out in such a study population of children with more severe chronic asthma who had acute flares.
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