In 2007, the NHLBI updated asthma guidelines suggesting a much lower dose of systemic corticosteroids for status asthmaticus. Accordingly, we revised our order set at Kosair Children's Hospital to reflect these changes by reducing the daily dose from 240 mg/day to 60 mg/day. The purpose of this study was to determine if decreasing the total daily dose of systemic corticosteroids affected the length of hospital stay.
A before-and-after chart review of patients hospitalized at Kosair Children's Hospital for status asthmaticus. Eligible patients had received methylprednisolone, prednisolone, or prednisone. Steroid dosing for Group 1 was 1 mg/kg/dose every 6 hours (max 240 mg/day) and 0.5–1 mg/kg/dose every 12 hours (max 60 mg/day) for Group 2. Inclusion criteria: patients < 18 years of age admitted with a diagnosis of status asthmaticus to a regular nursing unit who were prescribed steroids following one of the above protocols. Patients who were admitted to the intensive care unit were excluded. The primary outcome measure was the average length of stay between the two groups.
A total of 292 patients were identified, 152 patients in Group 1 and 141 patients in Group 2. The average length of stay for Group 1 = 2.01 days and Group 2 = 1.98 days (p = 0.8417) and average initial step of asthma therapy for both groups was Step 2. There was no effect on length of stay (p = 0.0833). In Group 1, 11 patients received intravenous magnesium sulfate compared with 10 patients in Group 2. No difference was found between the groups regarding length of stay (p = 0.7).
There was no statistically significant difference between groups with respect to length of stay due to the decrease in daily systemic corticosteroid dose. Therefore, we conclude that decreasing the daily dose of systemic corticosteroids for status asthmaticus does not affect the length of stay.
We conclude that lower dose ICS may be helpful in most children admitted with status asthmaticus. Further prospective studies are needed to confirm our findings.
Courtney Edwards, Consultant fee, speaker bureau, advisory committee, etc. AstraZeneca, Schering-Plough, Teva; No Product/Research Disclosure Information