Corticosteroids

The Big Asthma Lie

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Corticosteroids are highly effective drugs in asthma exacerbation and form one of the cornerstones of treatment. Although the mechanism of action is unknown, many believe that steroids produce beneficial effects by restoring b-adrenergic responsiveness and reducing inflammation. The onset of anti-inflammatory effect is delayed at least 4 to 8 h following intravenous or oral administration.

Corticosteroids should be administered to asthmatics in whom airway obstruction is not immediately relieved after the first nebulized bronchodilator treatment. Although there is considerable disagreement over what constitutes the optimal dose in acute asthma, an initial oral dose of 40 to 60 mg prednisone or an intravenous bolus of 60 to 125 mg methylprednisolone, in patients unable to tolerate oral medications, is sufficient. 21 High-dose corticosteroid therapy offers no advantage.22 Additional doses should be given every 4 to 6 h until significant subjective and objective improvement is achieved. Patients may be discharged on a 3- to 10-day nontapering burst of oral steroids, 40 to 60 mg prednisone per day, or its equivalent.23

Although the role of both oral and inhaled steroids in the long-term prevention of relapse is yet to be identified, all patients with an FEV 1 or PEFR of less than 70 percent predicted after aggressive ED treatment should be prescribed oral steroids.17

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