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Clinical InvestigationsComparison of High-Dose Inhaled Flunisolide to Systemic Corticosteroids in Severe Adult Asthma
Section snippets
Materials and Methods
All adult patients aged 18 to 55 years admitted from the ED to the inpatient medical service of Beth Israel Medical Center (BIMC) for an acute asthma exacerbation (International Classification of Disease code 493.91) were eligible for the study. The decision to hospitalize a patient on the inpatient medical service for an acute asthma exacerbation was made by senior BIMC ED staff. Implicit to study design is that the investigators had no involvement with the treatment or admission decision for
Results
Forty patients met the inclusion criteria, and all 40 patients were enrolled in the study. Twenty-one patients were randomized to the ICS group, and 19 patients were randomized to the prednisone group. One patient in the prednisone group completed only four doses of methylprednisolone in the hospital. One patient in the ICS group did not attend the follow-up appointment. This patient was interviewed by telephone, reported no readmission, and was able to measure PEFR at the time of the
Discussion
National Asthma Education and Prevention Program guidelines for the diagnosis and management of asthma recommend that patients with asthma of sufficient severity to require hospitalization be administered SS.1 They also recommend that the patient be discharged on oral corticosteroids at a recommended dose of 20 mg bid for 3 to 10 days.1 In addition, they recommend ICS should be started before the course of systemic corticosteroids is completed.1 The reason provided is that ICS have a gradual
ACKNOWLEDGMENT
The authors thank Paul Bailyn, PhD (Chairman, Mathematics Department, The Cooper Union, New York, NY) for statistical analysis.
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All work was performed at Beth Israel Medical Center.
Dr. Dayrit's current institutional affiliation is The Regional Medical Center, Orangeburg and Calhoun Counties, Orangeburg, SC.
This research was supported by a grant from Forest Laboratories, Inc.