Received July 26, 2017; Accepted October 16, 2017; Published November 30, 2017
http://dx.doi.org/10.18081/2333-5106/015-06/345-353
Borchers Sichuan, Quan-Ming Zhou, Chao Gay, Zeng Wong, Guo Goh
Abstract
Currently, the recommended first-line treatment for an acute asthma attack (in the emergency department or urgent care setting) is an inhaled short-acting beta-2 agonist. If the patient does not respond well to treatment or has severe asthma, in addition to inhaled β2-agonists, systemic corticosteroids (SCS) could be given to control inflammation and prevent subsequent exacerbations. Although the effectiveness of SCS therapy has been proven, there is controversy concerning the choice of oral or intravenous (IV) routes. Even though IV SCS might control asthma exacerbation more quickly, it is associated with more complications. Thus, the oral route should be considered as a reasonable alternative other than the IV route. Moreover, although systemic dosing of 1-2 mg/kg body weight of oral steroids per day is common in practice, the evidence on the best dose regimen is sparse. A retrospective cohort study was conducted to evaluate the effect of high doses of intravenous methylprednisolone compared with oral methylprednisolone in treating acute asthmatic patients. All patients aged ≥15 years with acute asthma who were treated with systemic corticosteroids in a tertiary care emergency department from January 2013 to December 2015 were reviewed. Based on a chi-squared test for two independent groups, prior to matching, 87 patients in the oral group and 174 patients in the intravenous group met the selection criteria. The mean age was 47.5, with 51% being male. Regarding the presenting vital signs, the IV group had a higher respiratory rate and lower blood pressure at the time of presentation. After conducting a 1:1 match using the nearest-neighbor matching algorithm, 46 pairs were formed, being similar in baseline demographic characteristics, vital signs, and presenting PEF.
Keywords: Asthma; Methylprednisolone; Oral treatment; FEV1
References
1. Bateman ED, Hurd SS, Barnes PJ, et al. Global strategy for asthma management and prevention. GINA executive summary. Eur Respir J 2008; 31:143–178. [PubMed]
2. Miller MK, Johnson C, Miller DP, et al. Severity assessment in asthma: An evolving concept. J Allergy Clin Immunol 2005; 116:990–995. [PubMed]
3. Haldar P, Pavord ID, Shaw DE, et al. Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med 2008; 178:218–224. [PubMed]
4. Green RH, Brightling CE, Bradding P. The reclassification of asthma based on subphenotypes. Curr Opin Allergy Clin Immunol 2007; 7:43–50. [PubMed]
5. Nathan RA, Sorkness CA, Kosinski M, et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol 2004; 113: 59–65. [PubMed]
6. Laird NM, Ware JH. Random-effects models for longitudinal data. Biometrics 1982; 38:963–974. [PubMed]
7. Cnaan A, Laird NM, Slasor P. Using the general linear mixed model to analyse unbalanced repeated measures and longitudinal data. Stat Med 1997;16:2349–2380. [PubMed]
8. Sellebjerg F, Frederiksen JL, Nielsen PM, Olesen J. Double-blind, randomized, placebo-controlled study of oral, high-dose methylprednisolone in attacks of MS. Neurology 1998; 51:529–534. [PubMed]
9. Centers for Disease Control and Surveillance. Surveillance for asthma–United States, 1960–1995. MMWR Morb Mortal Wkly 1998; Rep 47(SS-1):1–28. [PubMed]
10. Aligne C, Auinger P, Byrd R, Weitzman M. Risk factors for pediatric asthma. Contributions of poverty, race, and urban residence. Am J Respir Crit Care Med 2000; 162:873–7. [PubMed]
11. McDaniel M, Paxson C, Waldfogel J. Racial disparities in childhood asthma in the United States: evidence from the National Health Interview Survey, 1997 to 2003. Pediatrics 2006; 117:868–77. [PubMed]
12. Salmond C, Crampton P, Hales S, Lewis S, Pearce N. Asthma prevalence and deprivation: a small area analysis. J Epidemiol Community Health 1999; 53:476–80. [PubMed]
13. Wright R, Mitchell H, Visness C, et al. Community violence and asthma morbidity: the Innercity Asthma Study. Am J Public Health 2004; 94:625–32. [PubMed]
14. Grainge CL, Lau LC, Ward JA, et al. Effect of bronchoconstriction on airway remodeling in asthma. N Engl J Med 2011; 364:2006–15. [PubMed]
15. Bergeron C, Al-Ramli W, Hamid Q. Remodeling in asthma. Proc Am Thorac Soc 2009;6:301–5. [PubMed]
16. Khetsuriani N, Kazerouni NN, Erdman DD, et al. Prevalence of viral respiratory tract infections in children with asthma. J Allergy Clin Immunol 2007;119:314–21. [PubMed]
17. Brar T, Nagaraj S, Mohapatra S. Microbes and asthma: The missing cellular and molecular links. Curr Opin Pulm Med 2012; 18:14–22. [PubMed]
18. Pollack CV, Jr, Pollack ES, Baren JM, et al. A prospective multicenter study of patient factors associated with hospital admission from the emergency department among children with acute asthma. Arch Pediatr Adolesc Med 2002;156:934–40. [PubMed]
19. Kelly HW. Levalbuterol for asthma: A better treatment? Curr Allergy Asthma Rep 2007;7:310–4. [PubMed]
20. Camargo CA, Jr, Gurner DM, Smithline HA, et al. A randomized placebo-controlled study of intravenous montelukast for the treatment of acute asthma. J Allergy Clin Immunol 2010;125:374–80. [PubMed]
21. Schuh S, Willan AR, Stephens D, Dick PT, Coates A. Can montelukast shorten prednisolone therapy in children with mild to moderate acute asthma. A randomized controlled trial? J Pediatr 2009;155:795–800. [PubMed]
22. Lin RY, Pesola GR, Bakalchuk L, et al. Rapid improvement of peak flow in asthmatic patients treated with parenteral methylprednisolone in the emergency department: A randomized controlled study. Ann Emerg Med 1999;33:487–94. [PubMed]
23. Rowe BH, Spooner C, Ducharme FM, Bretzlaff JA, Bota GW. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev 2001:CD002178. [PubMed]
24. Manser R, Reid D, Abramson M. Corticosteroids for acute severe asthma in hospitalised patients. Cochrane Database Syst Rev 2001:CD001740. [PubMed]
25. Ratto D, Alfaro C, Sipsey J, Glovsky MM, Sharma OP. Are intravenous corticosteroids required in status asthmaticus? JAMA 1988; 260:527–9. [PubMed]
26. Rodrigo GJ. Rapid effects of inhaled corticosteroids in acute asthma: An evidence-based evaluation. Chest 2006;130:1301–11. [PubMed]
