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INJECTED STEROIDS ARE VALUABLE IN SEVERE CHRONIC ASTHMA.

Some asthmatic patients require long-term systemic steroids, yet periodically have severe, even life-threatening exacerbations despite steroid therapy. A New York team studied 12 such patients, all of whom had a reversible bronchospastic component, in a double-blind crossover trial comparing daily oral prednisone (median dose, 12.5 mg/day) with intramuscular triamcinolone (360 mg at the beginning of the 3-month treatment period). Both treatments were followed by a 3-month washout period and 3 months of treatment with the other regimen. Patients were allowed to take additional prednisone tablets as needed throughout the study.

During the oral treatment period, there were 21 emergency room visits and 10 hospitalizations, including two episodes of respiratory failure; there were no ER or hospital admissions during parenteral treatment. Parenteral treatment was also associated with better peak expiratory flow rates and less use of oral steroids. Rates of steroid side effects were considerable with both treatments, but did not differ significantly between them.

This high-dose parenteral regimen clearly seems superior to the oral steroid regimen used. It is unclear whether higher-dose oral regimens would be as effective as this parenteral regimen, and whether they would generate additional adverse effects.

— ALK

Published in Journal Watch General Medicine March 5, 1991

Citation(s):

Ogirala RG et al. High-dose intramuscular triamcinolone in severe, chronic, life-threatening asthma. N Engl J Med 1991 Feb 28 324 585-589.

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