Chest
Volume 107, Issue 6, June 1995, Pages 1559-1563
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Clinical Investigations: Asthma
A Randomized Comparison of 100-mg vs 500-mg Dose of Methylprednisolone in the Treatment of Acute Asthma

https://doi.org/10.1378/chest.107.6.1559Get rights and content

There have been conflicting reports comparing the effects of various doses of corticosteroids in the treatment of acute asthma. The purpose of this study was to compare 100 mg with 500 mg of methylprednisolone in the emergency department treatment of acute asthma. We studied 150 patients presenting to the emergency department with acute asthma. After baseline pulmonary function testing, patients were treated with oxygen and hourly administration of aerosolized albuterol. Patients were randomized to receive either 100 or 500 mg of methylprednisolone intravenously. Spirometry was repeated at 3 h, and again at 5 h for those patients whose dyspnea had not resolved after 3 h. There was no difference in the FEV1 between the 500-mg and 100-mg dose groups either before treatment (38.0% vs 32.6% of predicted normal) or after treatment (55.3% vs 51.9% of predicted normal). There was no difference in the percentage improvement in FEV1 with treatment between the 500-mg and 100-mg dose groups (65.0% vs 71.2%). Twenty-five percent of the patients in the 500-mg dose group were admitted to the hospital compared with 28% of patients in the 100-mg dose group (not significant). We conclude that the administration of a 500-mg dose of methylprednisolone offers no advantages over a 100-mg dose in the emergency department treatment of acute asthma.

Section snippets

Methods

This study was performed in the emergency department of MetroHealth Medical Center, Cleveland, a large, urban, county-owned, university-affiliated, hospital. Adult patients presenting with an acute exacerbation of asthma were eligible for enrollment in the study. Patients with a known history of asthma were included if they presented with wheezing, dyspnea, or both along with an FEV1 that was below 75% of the predicted normal value. Patients were excluded if they had a history of COPD, lung

Results

This study was performed between February 1992 and August 1993. One hundred fifty patients were enrolled in the study, including 96 women and 54 men with an average age of 34.7 ± 11.6 years. There were 48 current and 19 past cigarette smokers with an average of 22.3 ± 18.6 pack-years of cigarette use. Sixty-nine (46%) patients were using theophylline products; 123 (82.6%) of the patients were using β-agonist inhalers; 10 (6.7%) patients were using ipratropium bromide (Atrovent) inhalers; 30

Discussion

A number of investigators have compared differing doses of corticosteroids in the treatment of asthma. Haskell et al6 studied 25 hospitalized patients treated with 15, 40, or 125 mg of methylprednisolone. They found that the conditions of patients in the 125-mg dose group improved significantly by the first day while the conditions of those in the 40-mg and 20-mg dose groups did not improve until the second and third days, respectively. Overall, the improvement in FEV1 of the 125-mg and 40-mg

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    revision accepted October 11.

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