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Oral steroids are as effective as intravenous steroids in acute severe asthma

Three Part Question

In [patients with acute severe asthma] are [oral prednisolone as good as intravenous hydrocortisone] in [improving respiratory symptoms]?

Clinical Scenario

A 24 year old male with asthma presents to the Emergency Department with severe wheeze and dyspnoea. While nebulised bronchodilators are being administered you wonder whether it is better to prescribe oral or intravenous steroids.

Search Strategy

Medline 1966-3/99 using the OVID interface.
{exp asthma OR} AND ([{exp steroids OR steroid$.mp OR exp prednisolone OR} AND {exp administration, oral OR}] AND [{exp steroids OR steroid$.mp OR} AND {exp infusions,intravenous OR exp injections, intravenous OR}]) LIMIT to human and english language.

Search Outcome

66 papers found of which 60 were irrelevant to the study question and one of insufficient quality for inclusion. All but one paper was included in a metaanlysis.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Rowe BH et al
30 PRCTs of which * addressed the issue of oral vs intravenous therapyMetaanalysisEffectiveness in acute exacerbationsno significant difference
Barnett PL et al
49 children with moderate to severe asthma. 2 mg/kg oral methylprednisolone (23) vs 2 mg/kg intravenous prednisolone (26)PRCTRespiratory rate, FEV1, oxygen saturationno significant differenceFollow up only 4 h. No power study
Admission rateno significant difference


There is no good evidence for the superiority of either route of administration but all studies to date have been on very small numbers of patients. These studies may well have been of insufficient power to detect real differences (type II error).

Clinical Bottom Line

Steroids should continue to be given intravenously if intravenous access is necessary for other drugs or if the patient cannot take drugs by mouth. In other cases oral administration is acceptable.


  1. Rowe BH, Keller JL, Oxman AD et al. Effectiveness of steroid therapy in acute exacerbations of asthma: a meta-analysis. Am J Emerg Med 1992;10:301-310.
  2. Barnett PL, Caputo GL, Baskin M et al. Intravenous versus oral corticosteroids in the management of acute asthma in children. Ann Emerg Med 1997;29:212-217.