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Am Fam Physician. 2005;71(7):1414

Asthma exacerbations account for a significant number of emergency department visits. Corticosteroids have been shown to successfully manage acute exacerbations. However, relapse rates are still high. Previous studies have explored the use of single intramuscular doses of long-acting corticosteroids to reduce pharmacy visits and possibly nonadherence. These studies have demonstrated positive and negative outcomes 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 study included adult patients expected to be discharged from the emergency department with a diagnosis of acute asthma exacerbation. The diagnoses were based on American Thoracic Society Guidelines for the evaluation of patients with asthma. Participants also met specific spirometry requirements. During the emergency department visit, the participants received standard asthma treatments. Before discharge, they were randomized to receive a 160-mg intramuscular depot 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 outcome was relapse, which was identified by the need for unscheduled care for persistent or worsening asthma within 10 days of emergency department discharge.

The study included 180 patients who were 18 to 45 years of age. The relapse rate at 10 days was 14.1 percent for the intramuscular methylprednisolone group and 13.6 percent for the oral methylprednisolone group. The relapse rate at 21 days was 18.5 percent and 22.7 percent, respectively. Neither difference was significant. Adverse effects of intramuscular administration were more common in patients receiving methylprednisolone than in those receiving placebo. Patients receiving active intramuscular medication also reported more pain and bruising.

The authors conclude that a single intramuscular injection of methylprednisolone seems to be a viable treatment option for adults with acute asthma exacerbation. Physicians should choose the route of administration based on each patient’s financial situation and the risk of noncompliance.

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