Effect of high-dose intramuscular triamcinolone in older adults with severe, chronic asthma

Life threatening asthma is a serious condition that is often difficult to treat. Often, despite maximal medical therapies, these patients remain functionally crippled. In addition, older patients are even more susceptible to asthma as they are less able to adapt to or tolerate the symptoms. In this paper we report the effectiveness of a new treatment regimen of high-dose intramuscular triamcinolone (360 mg) in 7 elderly patients with severe, chronic, steroid-dependent asthma. Each patient was given one intramuscular injection of 360 mg of triamcinolone (Kenalog) after maximizing traditional medicines. All 7 patients experienced resolution of their asthma symptoms within 1 week of receiving this injection. They showed marked functional improvement in their activities of daily living, and independence. Six of seven progressed from being homebound to walking, shopping, and grooming without restriction. All had a corresponding rise in peak expiratory flow rates ranging between 25 and 93%. In addition, all were able to stop taking their daily oral prednisone. Response durations ranged from 3 to 24 months. In the 6 patients who experienced relapse, all requested and received a second injection, with similar positive outcomes. Some experienced transient weakness and diabetes during the first week of the therapy but all elected to receive additional shots when they experienced break-through wheezing. Thus, we feel that high-dose intramuscular triamcinolone should be considered as a therapeutic option for a highly select group of older steroid-dependent asthma patients.