Rapid improvement of peak flow in asthmatic patients treated with parenteral methylprednisolone in the emergency department: A randomized controlled study

Study objective: Corticosteroids are thought to exert their physiologic eff ects in asthma over the course of several hours. In this study we tested th e hypothesis that intravenous methylprednisolone improves airflow in a shor ter time frame (2 hours) in adults with acute asthma. Methods: In a randomized, double-blind, placebo-controlled trial, 56 adult asthmatic patients with peak expiratory flow rates (PEFRs) less than 50% pr edicted after an initial albuterol aerosol treatment were studied. These pa tients were randomly assigned to treatment with either 125 mg of intravenou s methylprednisolone or an equivalent volume of normal saline solution (pla cebo). Patients were also treated with identical schedules of nebulized ipr atropium and albuterol. Patients were recruited from an emergency departmen t at an urban academic medical center. The primary endpoints were changes i n PEFR and in percent predicted PEFR over time. PEFRs were assessed at base line and at 1 and 2 hours. Heart rate changes over time and the proportion of admissions in the 2 groups were also compared. Results: The increases in PEFR and percent predicted PEFR over time were bo th significantly greater in the methylprednisolone treatment group (P=.002 and P=.005, respectively). The increases in geometric mean peak flow at 60 and 120 minutes were 79 and 96 L/min for the methylprednisolone group and 5 4 and 68 L/min for the placebo group. There was also a significantly differ ent change in heart rates with time between the methylprednisolone and plac ebo groups (P=.029), with the placebo group showing a moderate increase in heart rate over time. Although the proportion of patients admitted for stat us asthmaticus was less in the methylprednisolone treatment group (8/30) co mpared with the placebo group (10/26), this difference in proportions (-.11 8, 95% confidence interval -.363 to .127) was not significant. Conclusion: These data suggest that use of corticosteroids should be consid ered relatively early in the treatment of patients with acute asthma in who m initial bronchodilator therapy fails to produce an adequate response.