Study objectives: To assess whether IV
methylprednisolone exerts a specific early effect on dyspnea in
patients with an exacerbation of asthma.
Randomized, placebo-controlled, double-blind crossover trial.
Setting: Medium-sized university general hospital.
Patients: Twenty-five asthma patients attending the chest
clinic with spontaneous complaints of increases in dyspnea and with a
Borg scale dyspnea rating ≥ 1 at rest.
Interventions: At 0 min, IV methylprednisolone (125 mg) vs
saline solution; at 60 min, 5 × 500 μg terbutaline inhaled from an
Measurements and results: Change in
dyspnea was assessed with bipolar visual analog scale (VAS) (much more
short of breath, −100%; much less short of breath, + 100%),
FEV1, and visual memory (using the Benton visual retention
test). Eighteen subjects (mean age, 61 years) completed the study. At 5
min and 60 min, shortness of breath improved with no statistically
significant difference between saline solution and methylprednisolone.
The mean (SD) VAS rating at 60 min was 29% (39%) on the day that
saline solution was administered and 36% (25%) on the day the steroid
was administered. FEV1 and Benton score did not
significantly change from baseline on either study day. Shortness of
breath and FEV1 improved following terbutaline
administration, with no significant difference between the days on
which saline solution and the steroid were administered. In the seven
subjects who were randomized to receive methylprednisolone on the first
day, baseline dyspnea rated on the Borg scale was significantly lower
on the second day (first day: median, 3; range, 3 to 4; second day:
median, 2; range, 0.5 to 3; p = 0.040).
We conclude that in patients with an exacerbation of asthma, an IV
bolus of methylprednisolone does not reduce dyspnea more than saline
solution after 5 min and 60 min.