Chest
Clinical Investigations: AsthmaA Randomized Comparison of 100-mg vs 500-mg Dose of Methylprednisolone in the 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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Cited by (34)
Evaluation and management of the critically ill adult asthmatic in the emergency department setting
2021, American Journal of Emergency MedicineCitation Excerpt :While the onset of action is typically within the first 6 h after administration, studies suggest that glucocorticoids administered early in the management of patients with severe exacerbation (specifically within the first hour) reduce the overall need for hospital admission [127-131]. In severe exacerbations, methylprednisolone 80–125 mg intravenous (IV) may be administered [9,10,14,130-133]. Doses higher than this are not recommended, as higher doses do not reduce duration of stay, reduce duration of endotracheal intubation, or improve respiratory function, while increasing risk of complications such as hyperglycemia, neurologic side effects (e.g., anxiety, delirium), myopathy, infection, and gastrointestinal bleeding [134,135].
Asthma
2012, Emergency Medicine: Clinical Essentials, SECOND EDITIONPharmacological treatment in asthma and COPD
2009, Allergology InternationalThe management of acute severe asthma
2002, Journal of Emergency MedicineStatus asthmaticus and hospital management of asthma
2001, Immunology and Allergy Clinics of North AmericaCitation Excerpt :Also, rates of absorption have not been well studied in seriously ill patients. The optimal timing of the first dose and the most effective dose, frequency, and route of administration are still unknown.54,71 Because of these considerations, and where the concern is that a maximal therapeutic level be reached as soon as possible (especially true with status asthmaticus), the IV agent may be preferable to oral steroids.
Presented at the Scientific Assembly of the American College of Chest Physicians, Orlando, Fla, October 1993.
revision accepted October 11.