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Corticosteroids in asthma.

V Chechani1

  • 1Department of Medicine, University of Missouri-Columbia.

Journal of the Association for Academic Minority Physicians : the Official Publication of the Association for Academic Minority Physicians
|January 1, 1991
PubMed
Summary

Intravenous corticosteroids are effective for acute asthma exacerbations, with specific dosing recommendations for hydrocortisone and methylprednisolone. Inhaled corticosteroids are crucial for managing poorly controlled asthma, even in early treatment phases.

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Area of Science:

  • Pulmonology
  • Pharmacology
  • Internal Medicine

Background:

  • Corticosteroids are vital for managing both acute and chronic asthma.
  • Intravenous corticosteroid administration has demonstrated benefits in acute asthma exacerbations.
  • Therapeutic approaches vary regarding corticosteroid type, dosage, and administration schedules.

Purpose of the Study:

  • To analyze existing studies on intravenous corticosteroid therapy for acute asthma.
  • To provide guidance on corticosteroid tapering after acute exacerbations.
  • To discuss the role and practical application of inhaled corticosteroids in adult asthma management.

Main Methods:

  • Review and analysis of randomized and non-randomized trials on intravenous corticosteroids in acute asthma.
  • Clinical approach outlined for corticosteroid tapering.
  • Discussion of hypothalamic-pituitary-adrenal axis suppression and management strategies.

Main Results:

  • Optimal initial doses suggested: hydrocortisone (4 mg/kg) or methylprednisolone (125 mg).
  • Recommended follow-up: continuous hydrocortisone infusion (12 mg/kg/24h) or methylprednisolone bolus (125 mg q6h).
  • Methylprednisolone may offer pharmacologic advantages over hydrocortisone.

Conclusions:

  • Specific intravenous corticosteroid regimens are proposed for acute asthma.
  • Inhaled corticosteroids are highly effective for asthma not controlled by bronchodilators and can be used early in treatment.
  • Practical guidelines for inhaled corticosteroid use in asthma are presented.

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