Does an IV bolus of methylprednisolone relieve dyspnea in asthma exacerbations?

Study objectives: To assess whether IV methylprednisolone exerts a specific early effect on dyspnea in patients with an exacerbation of asthma. Design: Randomized, placebo-controlled, double-blind crossover trial. Setting: Medium-sized university general hospital. Patients: Twenty-five asthma patients attending the chest clinic with spont aneous complaints of increases in dyspnea and with a Borg scale dyspnea rat ing greater than or equal to 1 at rest. Interventions: At 0 min, IV methylprednisolone (125 mg) vs saline solution; at 60 min, 5 x 500 mug terbutaline inhaled from an inhaler device. Measurements and results: Change in dyspnea was assessed with bipolar visua l analog scale (VAS) (much more short of breath, -100%; much less short of breath, + 100%), FEV1, and visual memory (using the Benton visual retention test). Eighteen subjects (mean age, 61 years) completed the study. At 5 mi n and 60 min, shortness of breath improved with no statistically significan t difference between saline solution and methylprednisolone. The mean (SD) VAS rating at 60 min was 29% (39%) on the day that saline solution was admi nistered and 36% (25%) on the day the steroid was administered. FEV1 and Be nton score did not significantly change from baseline on either study day. Shortness of breath and FEV1 improved following terbutaline administration, with no significant difference between the days on which saline solution a nd the steroid were administered. In the seven subjects who were randomized to receive methylprednisolone on the first day, baseline dyspnea rated on the Borg scale was significantly lower on the second day (first day: median , 3; range, 3 to 4; second day: median, 2; range, 0.5 to 3; p = 0.040). Conclusions: We conclude that in patients with an exacerbation of asthma, a n IV bolus of methylprednisolone does not reduce dyspnea more than saline s olution after 5 min and 60 min.