Comparison of Oral (Prednisolone) Versus Intravenous (Hydrocortisone) Steroids in Acute Exacerbation of Bronchial Asthma in Hospitalized Patients

Objective: To compare the efficacy of oral versus intravenous corticosteroids in improving peak expiratory flow (PEF) in patients admitted with acute exacerbation of asthma. Methodology: This randomized controlled trial was conducted from October 17, 2018, to April 16, 2019, at the Department of Pulmonology, PIMS, Islamabad. A total of 166 patients (18–65 years, both genders) with a documented history of bronchial asthma presenting with acute exacerbation were enrolled. Patients were randomly assigned to Group A (intravenous hydrocortisone 100 mg every 8 hours for 72 hours) or Group B (oral prednisolone 60 mg once daily for 72 hours). Both groups received standard bronchodilator therapy with nebulized salbutamol 2.5 mg/2.5 ml four times daily and as needed. PEF was measured before and after salbutamol at baseline, every 6 hours for 72 hours, and twice daily until discharge. The percentage change in PEF from baseline was assessed at 72 hours and compared using an independent sample t-test. Results: At baseline, mean PEF was 409.3 ± 65.4 L/min in Group A and 408.7 ± 69.2 L/min in Group B (p=0.956). After 72 hours, PEF improved to 545.3 ± 64.4 L/min in Group A and 539.7 ± 67.2 L/min in Group B (p=0.594). The mean percentage change in PEF was 34.2% ± 6.4 in Group A and 33.1% ± 6.5 in Group B (p=0.274). Conclusion: Oral corticosteroids were found to be equally effective as intravenous corticosteroids in treating acute asthma exacerbations. Given their cost-effectiveness, ease of administration, and patient comfort, oral corticosteroids should be preferred whenever possible.