INTRAMUSCULAR HIGH-DOSE TRIAMCINOLONE ACETONIDE IN THE TREATMENT OF SEVERE CHRONIC ASTHMA

We describe our experience with administering intramuscular triamcinol one acetonide to 22 steroid-dependent patients with asthma. These pati ents represent the minority of those with asthma whose disease is char acterized by frequent emergency department visits, hospital admissions , and long-term dependency on oral corticosteroid therapy. The partici pants were randomly assigned to 2 treatment groups, one group receivin g 120 mg of intramuscular triamcinolone acetonide, the second receivin g 360 mg as a series of three 120-mg daily doses. We determined relati ve efficacy by comparing peak expiratory flow rates and incidents of e mergency department visits, hospital admissions, and ventilatory failu re of the study and during the 12 months before enrollment. Peak expir atory flow rates improved significantly in both groups. The mean (+/- standard deviation I:SDI) monthly percentage of predicted peak expirat ory flow on the study was 88.6 +/- 3.7% and 91.2 +/- 3.9% compared wit h 63 +/- 15.1% and 64 +/- 14.5% at entry in patients receiving 120 and 360 mg, respectively (P < 0.02). Patients receiving 120 mg required 8 hospital stays and 8 emergency department visits compared with 27 hos pital stays and 72 emergency department visits in the previous year (P < 0.05). Patients receiving 360 mg required 5 hospital stays and 5 em ergency department visits compared with 33 hospital stays and 34 emerg ency department visits in the previous year (P < 0.05). The average mo nthly interval (+/- SD) between exacerbations was 2.7 +/- 2.3 and 7.8 +/- 3.5 for patients receiving 120 mg and 360 mg, respectively. A tota l of 25 intubations was required in the previous year and only 1 durin g the study. The incidence of cushingoid facies, weight gain, and hype rtension was reduced in both groups (P < 0.05). Total steroid use was reduced in both groups (P < 0.02). A dose of 360 mg produced a longer exacerbation-free period than 120 mg (P < 0.02).