These somewhat contradictory results are likely to relate to differences in study populations and study design. Very ill patients with impending respiratory failure may benefit from a larger IV dose initially, whereas the majority of patients are likely to do well without such high doses. Ellul-Micallef and Fenech showed that although hydrocortisone and prednisolone had a somewhat earlier onset of action when given IV to patients with asthma, the differences were small and the improvement in expiratory flow was eventually equal. An advantage of IV therapy seems therefore to be present only when the patients are unable to take their drugs by mouth or when a large dose is deemed advisable because of impending respiratory failure. With currently available oral preparations of SRT that are well absorbed, there is little advantage in giving these drugs by the IV route, unless patients are unable to take these drugs by mouth. The lack of reliable objective means by which to assess the severity of obstruction continues to make the choices of treatment a matter of clinical judgment. fml eye drops
We concluded that oral administration is acceptable therapy in hospitalized patients with moderate exacerbations of airways obstruction. The advantages of oral use are many and include lower cost, less discomfort and immobility associated with infusion, and a choice of outpatient treatment. In the current study more intensive use of inhaled medication in-hospital may have been an advantage to some patients. Still, the value of short courses of corticosteroids administered by mouth in the outpatient setting has been shown, and hospital admissions have been avoided by administration of steroids in the emergency room. It is likely that a considerable number of attacks of airways obstruction can be treated effectively in this way, using oral glucocorticoids and theophylline in conjunction with inhaled β-agonists.