Steroids in Acute Asthma: Oral, IV, or Inhaled?

The benefit of systemic corticosteroid therapy in the management of severe asthma is widely accepted, and both oral and parenteral preparations have proved effective. Some studies have suggested that inhaled corticosteroids provide an effective alternative to systemic steroids during ED treatment of acute asthma exacerbations. These authors in Uruguay reviewed the literature on all preparations of corticosteroids used to treat acute asthma in the ED.

A total of 16 randomized, placebo-controlled trials were analyzed. Composite analysis revealed that only high doses of inhaled corticosteroids were associated with an improvement in pulmonary function at the three hour assessment. IV steroids had a much slower onset to more moderate, but still s…