Comparison of high-dose inhaled flunisolide to systemic corticosteroids in severe adult asthma

Chest. 2002 Oct;122(4):1208-13. doi: 10.1378/chest.122.4.1208.

Abstract

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.

Design: Randomized, double-blind, placebo-controlled study.

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

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

Interventions: 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.

Measurements and 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.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adolescent
  • Adrenal Cortex Hormones / administration & dosage*
  • Adult
  • Albuterol / administration & dosage
  • Asthma / diagnosis
  • Asthma / drug therapy*
  • Confidence Intervals
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Drug Administration Schedule
  • Drug Therapy, Combination
  • Female
  • Fluocinolone Acetonide / administration & dosage*
  • Fluocinolone Acetonide / analogs & derivatives*
  • Follow-Up Studies
  • Hospitals, Urban
  • Humans
  • Infusions, Intravenous
  • Male
  • Methylprednisolone / administration & dosage
  • Middle Aged
  • Prednisone / administration & dosage
  • Probability
  • Respiratory Function Tests
  • Severity of Illness Index
  • Statistics, Nonparametric
  • Treatment Outcome

Substances

  • Adrenal Cortex Hormones
  • Fluocinolone Acetonide
  • Albuterol
  • flunisolide
  • Prednisone
  • Methylprednisolone