Comparing the efficacy and safety of two regimens of sequential systemic corticosteroids in the treatment of acute exacerbation of bronchial asthma

Praveen Aggarwal, Sanjeev Bhoi, Praveen Aggarwal, Sanjeev Bhoi

Abstract

Background: Corticosteroids are commonly used in the management of acute asthma. However, studies comparing various steroids in the management of acute asthma are lacking.

Objective: To compare the efficacy and safety of two treatment regimens - intravenous (IV) methylprednisolone (MP) followed by oral MP and IV hydrocortisone (HC) followed by oral prednisolone in acute bronchial asthma patients.

Materials and methods: This was a randomized, prospective study performed in the emergency department (ED) of a tertiary care hospital in North India. A total of 94 patients with acute asthma were randomly allocated to either of the two treatment groups: Group A (n = 49) or Group B (n = 45). Patients in Group A were administered HC 200 mg IV 6-hourly until discharge from the ED, followed by oral prednisolone 0.75 mg/kg daily for 2 weeks. Patients in Group B were administered MP 125 mg IV bolus, followed by 40 mg MP IV 6-hourly until discharge, and then oral MP 0.6 mg/kg daily for 2 weeks. All clinical variables, peak expiratory flow (PEF) and forced expiratory volume in one second (FEV(1)) were assessed at baseline, at 1, 3 and 6 h and at every 6 h thereafter until discharge from the ED. The patients were followed-up after 2 weeks of discharge. The response to treatment was assessed by clinical and spirometric evaluation. Independent t-tests and chi-square tests were used to compare the two treatment regimens.

Results: The baseline characteristics were comparable in the two groups. There was a significant improvement in PEF and FEV(1) within the groups at 2 weeks of treatment when compared to the baseline. At 2 weeks of follow-up, Group B showed significant improvement over Group A in PEF (P < 0.0001), FEV(1) (P < 0.0001) and asthma score (P = 0.034). There was a significant increase in the blood sugar value at 2 weeks in both the groups. However, the increase was greater in Group A as compared to Group B (P < 0.0001).

Conclusion: This study suggests that in acute asthma patients, IV MP followed by oral MP is a more efficacious and safer treatment regimen than IV HC followed by oral prednisolone.

Keywords: Acute asthma; asthma score; hydrocortisone; methylprednisolone; prednisolone.

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Flow diagram showing enrolment and allocation of patients to the two study groups
Figure 2
Figure 2
Mean peak expiratory flow (l/min) at various time points by treatment groups in acute asthma
Figure 3
Figure 3
Mean forced expiratory volume in one second at various time points by treatment groups in acute asthma

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Source: PubMed

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