The Effect Of Early Parenteral Administration Of Corticosteroids In Severe Asthma: A Study Not Employing Concomitant Ipratropium Treatment

摘要

There is studies in the medical literature that supports the use of parenteral corticosteroid and aerosolized anticholinergic treatments in acute asthma. Since study treatments often involve giving both agents, it is not known whether the beneficial effects of corticosteroids are similar in patient given beta adrenergic treatments alone compare to patients given both beta adrenergic and anticholinergic treatments. In this study, the effects of corticosteroid administration was studied in the absence of ipratropium treatment, in a protocol similar to that previously used by the investigators in a prior study that involved both albuterol and ipratropium treatments. Thirty seven adult patients with acute asthma were randomized to either 125 mg of intravenous methylprednisolone(n=19) or to saline(n=18) treatments in a double blinded study. As entry criteria, all patients were required to have significant peak flow reductions despite initial albuterol treatment. Identical regimens of repeated albuterol nebulization were administered to the patients, and peak flow measurements were made serially over 3 hours. Peak flow measurements showed no differences between the 2 groups in terms of change with time. There was also no significant difference in the proportion of patients who were admitted to the hospital for the two groups(steroid n=3, placebo n=2). In conclusion, our study did not show a benefit for parenteral corticosteroid administration in adults treated for acute severe asthma with only beta agonists. Background This study examined the effect of early corticosteroid administration on airway obstruction in emergency room adults asthmatics. In a prior study by us(1), the benefits of parenteral corticosteroids were observed in the presence of concomitant beta agonist and anticholinergic nebulizer treatment. Thus it could not be ascertained if corticosteroids effects required bronchodilator effects of one or both of these nebulized therapies. More specifically, it was not known if patients who received beta agonists therapy in the absence of ipratropium would also benefit from corticosteroid parenteral therapy. The goal of this study was thus to test the hypothesis that early corticosteroid therapy in severe acute asthma is beneficial in the absence of ipratropium treatment. Methods Asthmatic patients were considered for recruitment from the Emergency Department if they had a PEFR which was less than 50% predicted or an absolute PEFR value of less than 200 L/min, after having received an initial 2.5 mg albuterol nebulizer treatment twenty minutes previously. Exclusion criteria included 1) age less than 18 years old, 2) inability to perform peak expiratory flow(PEFR) measurements after the initial pre-study albuterol treatment, 3) smoking history of 10 or more pack years of cigarettes, and 4) pregnancy. Asthma was defined as 1) having a history of asthma diagnosed by a physician, 2) having had a bronchodilator prescribed by a physician, and 3) having had episodes of wheezing that improved with beta agonist inhalers.Patients in the study had all measurements of PEFR performed in the sitting position without nose clips. These were administered by the study physicians using a Wright peak flow meter(model N183JD, Ferraris Medical Ltd, London).. Percent predicted peak flow rates were calculated using the Quanjer prediction equations(2) for smokerson-smokers/ex-smokers which are based solely on age(years), sex, and height(meters). For males the equation for predicted peak flow(L/sec) was 5.48 x height(meters) - .041 x age(years) + 1.58. For females predicted peak flow was 3.72 x height(meters) - .03 x age(years) + 2.24. The recruited patients were randomized to treatment with either methyprednisolone or normal saline administration. Each treatment designation was placed in sealed, opaque envelopes stored in a locked cabinet. A staff member uninvolved with the patient's care then drew into a syringe either 125 mg of freshly dissolved m