Double-Blind Evaluation of Methylprednisolone Versus Placebo for Acute Asthma Episodes

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Abstract
Children (28) with persistent bronchospasm after outpatient therapy were treated for 8 days with methylprednisolone or placebo in a prerandomized double-blind manner, in addition to treatment with optimal oral bronchodilators. At follow-up visits 1, 7 and 14 days after onset of therapy, a history was taken and physical examination and pulmonary function tests were performed. Initially and on the 14th day, patients underwent cosyntropin tests of adrenal function. Patients kept daily peak flow charts. Both groups improved with time. By 24 h after starting methylprednisolone therapy, the placebo group continued to show reversibility after isoproterenol inhalation; the methylprednisolone group did not. By day 7 there were significantly more patients with normal 1-s forced expiratory volume (FEV1) and forced expiratory flow in the middle half of the forced vital capacity (FEF25-75%) in the methylprednisolone group and mean FEF25-75% was significantly higher for this group (P < 0.02). By day 14, six days after finishing treatment with the study drugs, more patients in the placebo group had residual wheezing but pulmonary function tests were now similar for the 2 groups. Although both groups showed a decline in cosyntropin responsiveness on day 14 compared with day 1, there was no difference between the steroid- and placebo-treated patients. Short-term corticosteroid therapy will accelerate resolution of moderately severe and severe-acute attacks of asthma without significant suppression of adrenal function.

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