Asthma: acute exacerbation: low dose steroids were less effective at improving lung function.

Clinical bottom line (level 1b)

  1. Doses of methylprednisolone 40 mg or more every six hours iv were more effective at improving FEV1 than 15mg every six hours in patients with status asthmaticus (NNT = 2 at 3 days) .
Haskell et al: Archives of Internal Medicine 1983; 143: 1324-1327
Expires November 2002

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: university hospital, USA

24 patients (aged mean 39 years, 75% female) with status asthmaticus (defined as PEFR < 50% predicted, not responding to conventional therapy with s/c beta-agonists, iv aminophylline and inhaled bronchodilators.)

Excluded if
  • chronic bronchitis, emphysema, pneumonia, heart failure, pulmonary embolism, upper airway obstruction, pneumothorax, pleural effusion, lung cancer, long-term mechanical ventilation in the past
  • other known cause of abnormal FEV1
  • contraindication to corticosteroids
  • on corticosteroids or barbiturates within 7 days of study


    • Control Group: (n = 8, 8 analysed): low dose methylprednisolone 15 mg every six hours for three days
    Experimental Group: (n = 16, 16 analysed): medium or high dose methylprednisolone 40 mg or 125 mg every six hours for three days
    All patients received iv aminophylline 0.6 to 0.9 mg/kg/hour to maintain serum levels 10 to 20 mg/l; inhaled beta-agonist bronchodilators every 4-6h; fluids iv and orally; supplemental oxygen if saturation < 90%
    100% followed for 3 days
    Outcome notes:
    • no significant improvement : 50% predicted FEV1 or less

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    no significant improvement 3 days 4
    (50.0%)    		 0
    (0.00%)    		 100%
    (0% to 300%)    		 50.0%
    (15.4% to 84.7%)    		 2
    (1 to 7)

  • The high dose group significantly improved at the end of the first day, whereas the medium dose group improved early in the second day.
  • There was no significant difference noted between the medium and high dose groups.

    • Comments

    1. There is no information about other important outcomes, such as duration of hospital stay, relapse rate, and mortality.

    Citation

    1. Haskell RJ, Wong BM, Hansen JE: a double-blind, randomized clinical trial of methylprednisolone in status asthmaticus. Archives of Internal Medicine 1983; 143: 1324-1327
    Search Terms: acute asthma in Cochrane
    Contributor: Chris Ball and Clare Wotton, November 2000
    Reviewer: Mitsuhiro Kamei

    Clinical Question.
    Patient status asthmaticus
    Intervention or Exposure high dose methylprednisolone
    Comparison low dose methylprednisolone
    Outcome peak flow