Asthma exacerbations account for a ...

Asthma exacerbations account for a significant number of pass department visits. Corticosteroids have been shown to favorably manage acute exacerbations. However, relapse rates are still high. Previous studies have explored the use of single intramuscular doses of long-acting corticosteroids to abate pharmacy visits and possibly nonadherence. These studies have demonstrated positive and negative results when comparing intramuscular and oral corticosteroids. Lahn and colleagues compared the efficacy of long-acting intramuscular methylprednisolone with an oral tapering course in the treatment of asthma exacerbation.

This prospective, randomized, placebo-controlled, double-blind reflection included adult patients expected to be discharged from the unforeseen occasion department with a diagnosis of acute asthma exacerbation. The diagnoses were based upon American Thoracic Society Guidelines for the evaluation of patients with asthma. Participants also met specific spirometry requirements. During the pinch department visit, the participants received standard asthma treatments. Before discharge, they were randomized to receive a 160-mg intramuscular station injection of methylprednisolone and an eight-day placebo oral regimen, or a placebo intramuscular injection and an eight-day tapering oral regimen of methylprednisolone. The primary issue was relapse, which was identified by dint of the need for unscheduled care for persistent or worsening asthma within 10 days of pass department discharge.

The studious mood included 180 patients who were 18 to 45 years of age. The relapse rate at 10 days was 141 percent for the intramuscular methylprednisolone assemblage and 13.6 percent for the oral methylprednisolone cluster The relapse rate at 21 days was 185 percent and 227 percent respectively. Neither difference was significant. Adverse events of intramuscular administration were more public in patients receiving methylprednisolone than in those receiving placebo. Patients receiving active intramuscular medication also reported more pain and bruising.

The authors terminate that a single intramuscular injection of methylprednisolone have the appearances to be a viable treatment option for adults with acute asthma exacerbation. Physicians should select the route of administration based onward each patient's financial situation and the risk of noncompliance.

Lahn M et al. Randomized clinical trial of intramuscular v oral methylprednisolone in the treatment of asthma exacerbations following discharge from an pressing necessity department. Chest August 2004;126:362-8.

COPYRIGHT 2005 American Academy of Family Physicians

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