Relative efficacy of hydrocortisone and methylprednisolone in acute severe asthma

The relative clinical efficacy of different types of intravenous glucocorticosteroids in acute severe asthma is not clear in published studies. We conducted a randomised prospective study of asthma unit admissions over a 3-month period. Therapy consisted of 4-hourly nebulised salbutamol, intravenous aminophylline and either intravenous hydrocortisone 200 mg 4-hourly or intravenous methylprednisolone 125 mg 12-hourly. Three hundred and eighty-six patients were admitted to the asthma unit. After exclusions, 191 patients were included in the analysis (hydrocortisone--91, methylprednisolone--100). The groups were comparable in respect of baseline data. The median time to maximum peak expiratory flow rate was 19 hours for hydrocortisone and 23 hours for methylprednisolone (median test, P = 0.21). Median duration of asthma unit stay was 30 hours for hydrocortisone and 36 hours for methylprednisolone (median test, P = 0.01). A similar difference was evident on comparison of the trial medications in patients who had previously been on oral maintenance steroids. We conclude that, at the dosages selected, hydrocortisone is more effective than methylprednisolone in acute severe asthma.