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Am Fam Physician. 2001;63(11):2268-2273

Current recommendations for the treatment of asthma include using inhaled bronchodilators as maintenance therapy and systemic corticosteroids for severe exacerbations. Corticosteroids take time (from six to 12 hours) to become effective and should not be used alone. However, some physicians believe that intravenous (IV) steroids provide relief in a short period of time. Noseda and associates studied the early effect of IV methylprednisolone on dyspnea in patients with acute exacerbations of asthma.

The study design was a randomized, placebo-controlled, double-blind crossover trial of 25 patients with asthma. Patients enrolled in the study had an established diagnosis of asthma and presented to the study center with increasing dyspnea. In addition, the patients had to rate their dyspnea as being at least “very slightly short of breath.” Patients were randomly assigned to receive 125 mg of IV methylprednisolone or placebo in a saline solution/steroid sequence or the reverse. They were assessed initially for dyspnea symptoms, spirometry and visual memory, and reassessed 60 minutes after receiving the IV infusion. All patients were then treated with terbutaline and reassessed five and 30 minutes after treatment.

When comparing the group that received IV methylprednisolone with the placebo group, no significant improvement in dyspnea was seen 60 minutes after treatment. In addition, there were no differences in spirometry changes between the two groups during that same period. After treatment with terbutaline, there was no difference in dyspnea and spirometry measurements between the two groups.

The authors conclude that IV methylprednisolone does not improve dyspnea in patients with asthma who are experiencing an acute exacerbation. They further state that this IV medication provided no more acute benefit for these patients than placebo. Although IV corticosteroids have a place in the treatment of asthma, they do not provide acute early relief in patients with asthma who are experiencing an acute exacerbation.

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