Comparison of high-dose inhaled flunisolide to systemic corticosteroids in severe adult asthma.
OBJECTIVE
To investigate whether, after 48 h of IV treatment with corticosteroids, the use of high-dose inhaled flunisolide is as effective as systemic corticosteroids in adults hospitalized for a severe asthma exacerbation.


METHODS
Randomized, double-blind, placebo-controlled study.


METHODS
Inpatient, an urban teaching hospital medical ward; outpatient, asthma clinic affiliated with the hospital.


METHODS
Forty patients aged 18 to 55 years with asthma exacerbation requiring hospitalization.


METHODS
Inhaled flunisolide via metered-dose inhaler (250 micro g per activation) eight puffs bid compared to systemic corticosteroids alone, following eight doses of IV corticosteroids.


RESULTS
Peak expiratory flow rate (PEFR), FEV(1), and symptom scores were recorded on day 1 (at presentation to the emergency department) and day 7, at an outpatient follow-up visit. From day 1 to day 7, mean PEFR increased from 190 to 379 L/min in the flunisolide group, and from 207 to 347 L/min in the systemic corticosteroids group (p = 0.95; 95% confidence interval [CI], - 66.3, infinity ). Mean FEV(1) increased from 1.6 to 2.3 L in the flunisolide group, and from 1.4 to 2.1 L in the systemic corticosteroids group (p = 0.33; 95% CI, - 21.7, infinity ). Changes in symptom scores were - 0.7 in the flunisolide group and - 0.9 in the systemic corticosteroids group (p = 0.39; 95% CI, - 0.4, infinity ). Hospital readmission rates on day 7 were zero for both groups.


CONCLUSIONS
High-dose inhaled corticosteroids are as effective as systemic corticosteroids during a 7-day period following admission to the hospital for severe asthma.
Lee-Wong
Mary
M
Division of Allergy/Immunology, Beth Israel Medical Center, Albert Einstein College of Medicine, 350 East 17th Street, 18 BH22, New York, NY 10003, USA.
Dayrit
Francis M
FM
Kohli
Anita R
AR
Acquah
Samuel
S
Mayo
Paul H
PH
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000420:Albuterol / Q000008:administration & dosage; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy*; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005446:Fluocinolone Acetonide / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D005500:Follow-Up Studies; D006786:Hospitals, Urban; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D011336:Probability; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D005446:Fluocinolone Acetonide; C007734:flunisolide; D000420:Albuterol; D011241:Prednisone; D008775:Methylprednisolone