If this is not your name, click here.
| | If this is not your name, click here. | | |
| | Contact Us | Order Now | Journals | Bookstore | Register a colleague | | |
| |  Very High-Dose Methylprednisolone Offers No Added Efficacy in Status Asthmaticus: Presented at PAS By Jill Stein BALTIMORE, Md -- May 4, 2009 -- Very high-dose intravenous methylprednisolone provides no additional benefit over standard high-dose methylprednisolone in children with status asthmaticus, investigators reported here at the 2009 Pediatric Academic Societies (PAS) Annual Meeting. Maria Corazon S. Hizon, MD, Flushing Hospital Medical Center, New York, New York, presented data from 85 patients younger than 18 years of age who received less than 60 mg/m2/day (high-dose group) or 60 mg/m2 or more per day (very high-dose group) at her institution over a recent 21-month period. She presented the findings here on May 3. "Asthma is mainly an inflammatory disease, and treatment of acute severe asthma includes beta2 agonists and systemic corticosteroids -- a mandatory first-line treatment for status asthmaticus," Dr. Hizon pointed out. "The National Heart, Lung, and Blood Institute recommends the use of methylprednisolone at 1 to 2 mg/kg/day, which amounts to about 30 to 60 mg/m2/day; however, there is a tendency among healthcare providers to prescribe higher doses for 'sicker' patients." Although short-term use of high-dose corticosteroids is usually safe, more is not necessarily better because of known side effects, Dr. Hizon added. The primary outcome measurements in this study were paediatric asthma severity score (PASS) at 12, 24, and over 48 hours after receiving methylprednisolone treatment. The investigators found no significant differences between the high-dose and very high-dose groups in terms of PASS at 12, 24, and over 48 hours after administration of methylprednisolone. At 12 hours post-treatment, PASS was 2.4 +- 1.1 and 2.9 +- 1.2 for the 2 groups, respectively (P = 0.052). At 24 hours, PASS was 1.4 +- 1.0 and 1.8 +- 1.2 for the 2 groups, respectively (P = 0.1). Finally, at over 48 hours, PASS was 0.5 +- 0.7 and 0.6 +- 0.9 for the 2 groups, respectively (P = 0.57). In addition, there were no significant differences in PASS percentages and rates of improvement between the groups at different intervals following administration of methylprednisolone. The length of stay (LOS) was significantly shorter in the group that received conventional high-dose methylprednisolone. That is, the conventionally dosed group had a mean LOS of 3.3 +- 0.9 days versus 3.9 +- 1.2 days for the very high-dose group (P = .01). The researchers also documented significantly higher systolic blood pressures at 12, 24, and over 48 hours following very high-dose methylprednisolone treatment. Dr. Hizon said that while the optimal amount of systemic corticosteroids for use in treating children with status asthmaticus has been an "unresolved issue," the results suggest that very high-dose methylprednisolone offers no advantages over the standard dose. [Presentation title: The Effects of Different High Doses of Methylprednisolone in Children With Status Asthmaticus. Abstract 3863.221]
|
