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Does an IV Bolus of Methylprednisolone Relieve Dyspnea in Asthma Exacerbations?^*

^* From the Pulmonary Division (Drs. Noseda and De Bruyne), Department of Internal Medicine, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium; the Medical Statistical Unit (Dr. De Maertelaer), Institut de Recheiche Interdisciplinaire en Biologie Humaine et Nudéaire, Brussels, Belgium; and the Chest Department (Dr. Yernault), Hpital Erasme, Free University of Brussels, Brussels, Belgium.

Correspondence to: André Noseda, MD, PhD, Department of Medicine, Pulmonary Division, CHU Brugmann, Place A. Van Gehuchten 4, B-1020 Brussels, Belgium.

Study objectives: To assess whether IV methylprednisolone exerts a specific early effect on dyspnea in patients with an exacerbation of asthma.

Design: 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 x 500 µg terbutaline inhaled from an inhaler device.

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).

Conclusions: 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.

Key Words: asthma exacerbation • dyspnea • methylprednisolone • visual analog scale

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