SELECTED ARTICLES FROM THE RECENT LITERATURE 2004

11/24/04

Methylprednisolone treatment by the I.M. vs oral route following in the therapy of an acute asthma exacerbation following discharge from the Emergency Department (ED)

Summary
Background - Asthmatic patients treated successfully in the ED for an acute exacerbation are generally discharged from such units with prescriptions for a tapered course of oral steroid therapy. However, questions have been raised whether a similar beneficial effect can be achieved by a single I.M. injection of a depol corticosteroid preparation.

Findings - Lahn et al of the Montefiore Medical Center in the Bronx, NY compared the efficacy of a single I.M. injection of 160 mg of a depol methylprednisolone preparation (Depo-Medrol) vs a tapered dosage 10 day course of oral methylprednisolone (total dose = 160 mg) in a group of 180 adult asthmatics. The patients were given one of these two therapies at the time of discharge from the ED after initial treatment of an acute asthma exacerbation.

By 10 days post-discharge from the ED, the asthma relapse rate was almost identical (about 14%) in those treated with either the IM depot methylprednisolone or the oral methylprednisolone regimens.

Reference
Chest 2004;126:362-8

Editor's Comments
These findings are not too surprising and provide evidence to support this single injection approach in asthmatic patients deemed by the ED staff (or on the basis of previous medical records) to be poorly compliant with prescribed medications. One would have liked to have seen results of additional assessments in this study such as nocturnal asthma awakenings, tolerance for usual physical activities, spirometry findings, etc.

Of course, if patient compliance with treatment is a concern one, has to decide what to do concerning follow-up therapy after 10 days post-discharge.

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