RELATIVE EFFICACY OF HYDROCORTISONE AND METHYLPREDNISOLONE IN ACUTE SEVERE ASTHMA

The relative clinical efficacy of different types of intravenous gluco corticosteroids in acute severe asthma is not clear in published studi es. We conducted a randomised prospective study of asthma unit admissi ons over a 3-month period. Therapy consisted of 4-hourly nebulised sal butamol, intravenous aminophylline and either intravenous hydrocortiso ne 200 mg 4-hourly or intravenous methylprednisolone 125 mg 12-hourly. Three hundred and eighty-six patients were admitted to the asthma uni t. After exclusions, 191 patients were included in the analysis (hydro cortisone - 91, methylprednisolone - 100). The groups were comparable in respect of baseline data, The median time to maximum peak expirator y flow rate was 19 hours for hydrocortisone and 23 hours for methylpre dnisolone (median test, P = 0,21). Median duration of asthma unit stay was 30 hours for hydrocortisone and 36 hours for methylprednisolone ( median test, P = 0,01). A similar difference was evident on comparison of the trial medications in patients who had previously been on oral maintenance steroids. We conclude that, at the dosages selected, hydro cortisone is more effective than methylprednisolone in acute severe as thma.