Comparison of the Oral and Intravenous Routes for Treating Asthma with Methylprednisolone and Theophylline: Discussion

5 Feb

We compared equivalent amounts of orally and IV administered methylprednisolone and theophylline in the treatment of acute exacerbations of airways obstruction. The patient groups were matched for age, smoking history, and severity of obstruction. We found the two forms of administration equally effective in improving symptomatic as well as spirometric evidence of obstruction in these patients with moderate obstruction. While there was considerable variability in the spirometric response to therapy within each group, most patients had an excellent clinical response, and none required a change in therapy or developed significant adverse effects. The average degree of obstruction, however, was relatively mild, and further studies are needed in more severe disease. Still, the patients with the lowest FEVi appeared to respond equally well to those with lesser degrees of obstruction, and response appeared to relate more to smoking history than to the original FEVX. The use of (3-agonists was not controlled but was comparable in the two groups and is likely to have contributed significantly to the overall improvement. patanol eye drops

The use of steroids in acute episodes of airway obstructions is now widely accepted, but recommendations for dosage have varied considerably. Haskell et al recently showed that patients with very severe asthma (mean FEVj <30 percent predicted) improved more quickly when given a large dose of steroids than a matched group who received a lower dose. The group given the lower dose had a satisfactory response, although a somewhat slower one. On the other hand, several studies have failed to reveal better results with high doses. Harfi et al could demonstrate no difference between large and conventional dose therapy in children with status asthmaticus, and recently Harrison et al could demonstrate no added benefit of giving IV hydrocortisone in addition to oral prednisolone to severely asthmatic patients not in ventilatory failure.