HIGH-DOSE AND LOW-DOSE SYSTEMIC CORTICOSTEROIDS ARE EQUALLY EFFICIENTIN ACUTE SEVERE ASTHMA

The optimal amount of systemic corticosteroids to be used in acute sev ere asthma remains an unresolved issue. In this double-blind, randomiz ed study we compared two doses of methylprednisolone (1 vs 6 mg . kg(- 1) q.d.) in asthmatics presenting with an acute severe asthma attack, unresponsive to an intensive beta(2)-agonist regimen administered duri ng a run-in period, Concurrent therapy, including oxygen, inhaled and intravenous salbutamol and aminophylline was strictly standardized, Th e response was assessed by serial bedside spirometry. The primary outc ome measurement was forced expiratory volume in one second (FEV(1)) (e xpressed as percentage of predicted values) at 24 and 44 h, The trial was designed in order to achieve a statistical power of 90%. Twenty th ree patients were included in the low-dose group and 24 in the high-do se group, Both groups were comparable in terms of demographic profiles , history of asthma, and severity of the current attack. Improvement i n pulmonary function was similar in both groups, At 44 h, the mean (+/ -SD) FEV(1) values were 53+/-22 and 45+/-14% in the low and in the hig h-dose group respectively (NS).We conclude that high dose systemic cor ticosteroids offer no further benefit over low-doses in the treatment of severe acute asthma.