Randomized clinical trial of intramuscular vs oral methylprednisolone in the treatment of asthma exacerbations following discharge from an emergency department.
OBJECTIVE
To compare the efficacy of long-acting IM methylprednisolone to tapering oral methylprednisolone in adult asthmatic patients discharged from the emergency department (ED).


METHODS
Randomized, double-blind, placebo-controlled trial of a single IM dose of 160 mg depot methylprednisolone vs 8-day tapering of a total dose of 160 mg oral methylprednisolone in adult asthmatic patients (age range, 18 to 45 years) who were discharged from the ED following standardized treatment for an acute exacerbation. The primary end point was relapse, which was defined as the need to seek unscheduled care at a doctor's office, clinic, or ED for symptoms of persistent or worsening asthma within 10 days of ED discharge.


RESULTS
Of 190 patients enrolled into the study, 180 completed the study and the follow-up at 10 days (96%). The relapse rate was nearly identical for the two treatment groups (IM administration, 14.1% [13 of 92 patients]; oral administration, 13.6% [12 of 88 patients]; difference, 0.5% [95% confidence interval, - 9.6 to 10.6%]).


CONCLUSIONS
Single-dose IM methylprednisolone administered to adult asthmatic patients at ED discharge appears to be a viable therapeutic alternative to a course of oral methylprednisolone. Clinicians may choose to base the route of administration of corticosteroids on concerns about nonadherence to therapy or on the ability of a patient to afford a prescription for outpatient medication.
Lahn
Michael
M
Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th St, Bronx, NY 10467, USA.
Bijur
Polly
P
Gallagher
E John
EJ
D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D003188:Composite Resins; D003692:Delayed-Action Preparations; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D012008:Recurrence
D003188:Composite Resins; D003692:Delayed-Action Preparations; C034577:Exact composite resin; D008775:Methylprednisolone