Chest
Volume 122, Issue 4, October 2002, Pages 1208-1213
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Clinical Investigations
Comparison of High-Dose Inhaled Flunisolide to Systemic Corticosteroids in Severe Adult Asthma

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Objective

To investigate whether, after 48 h of IV treatment with corticosteroids, the use of high-dose inhaled flunisolide is as effective as systemic corticosteroids in adults hospitalized for a severe asthma exacerbation.

Design

Randomized, double-blind, placebo-controlled study.

Setting

Inpatient, an urban teaching hospital medical ward; outpatient, asthma clinic affiliated with the hospital.

Participants

Forty patients aged 18 to 55 years with asthma exacerbation requiring hospitalization.

Interventions

Inhaled flunisolide via metered-dose inhaler (250 μg per activation) eight puffs bid compared to systemic corticosteroids alone, following eight doses of IV corticosteroids.

Measurements and results

Peak expiratory flow rate (PEFR), FEV1, and symptom scores were recorded on day 1 (at presentation to the emergency department) and day 7, at an outpatient follow-up visit. From day 1 to day 7, mean PEFR increased from 190 to 379 L/min in the flunisolide group, and from 207 to 347 L/min in the systemic corticosteroids group (p = 0.95; 95% confidence interval [CI], − 66.3, ∞). Mean FEV1 increased from 1.6 to 2.3 L in the flunisolide group, and from 1.4 to 2.1 L in the systemic corticosteroids group (p = 0.33; 95% CI, − 21.7, ∞). Changes in symptom scores were − 0.7 in the flunisolide group and − 0.9 in the systemic corticosteroids group (p = 0.39; 95% CI, − 0.4, ∞). Hospital readmission rates on day 7 were zero for both groups.

Conclusions

High-dose inhaled corticosteroids are as effective as systemic corticosteroids during a 7-day period following admission to the hospital for severe 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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  • Cited by (0)

    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.

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