Intravenous administration of corticosteroids and theophylline has been considered superior to oral use in treating acute episodes of airways obstruction. The intravenous (IV) route is thought to be more reliable, and there is evidence for an earlier onset of steroid action when given IV However, this may not be of clinical importance in the majority of patients. There is currently no consensus regarding the appropriate dose of steroids in acute airways obstruction and the role of theophylline is the subject of active debate and investigation. While some recent data favor a larger dose of steroids than could be given orally in patients with severe asthma, most studies have failed to show an advantage of high doses. Intravenous administration has the disadvantage of requiring hospitalization, being expensive, being associated with some morbidity, and encouraging the use of a larger dose than may be needed. This study was undertaken to assess the relative efficacy of equivalent amounts of oral and IV methylprednisolone and theophylline in patients with acute airways obstruction admitted to our hospital. To our knowledge such a study had not been done previously. xalatan generic
Material and Methods
Patients over the age of 20 years with a history of obstructive airways disease who were admitted to the Vifilsstadir Chest Hospital with recent worsening of dyspnea and wheezing were considered for study Most patients had been treated previously at the hospital and were admitted directly to the pulmonary ward without emergency room therapy. We excluded those patients known to have irreversible chronic obstructive pulmonary disease and those with respiratory failure, pneumonia, or heart failure. Patients who had received more than a maintenance dose of glucocorticoid in the two weeks preceding admission were also excluded.
The study was approved by the Icelandic Ministry of Health. All patients gave informed consent after receiving an explanation of the protocol. A history and physical examination were performed by one of the investigators. Each patient then underwent spirometric evaluation using a dry wedge spirometer (Vitalograph Limited). Three forced exhalations were performed, and the best value for forced vital capacity and forced expiratory volume in one second were used.