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Comparison of High-Dose Inhaled Flunisolide to Systemic Corticosteroids in Severe Adult Asthma^*

^* From the Divisions of Allergy/Immunology (Drs. Lee-Wong and Kohli) and Pulmonary/Critical Care Medicine (Drs. Mayo, Dayrit, and Acquah), Beth Israel Medical Center, Albert Einstein College of Medicine, New York, NY.

Correspondence to: Mary Lee-Wong, MD, Beth Israel Medical Center, 350 East 17th St, 18 BH22, New York, NY 10003

Objective: To investigate whether, after 48 h of IV treatment with corticosteroids, the use of high-dose inhaled flunisolide is as effective as systemic corticosteroids in adults hospitalized for a severe asthma exacerbation.

Design: Randomized, double-blind, placebo-controlled study.

Setting: Inpatient, an urban teaching hospital medical ward; outpatient, asthma clinic affiliated with the hospital.

Participants: Forty patients aged 18 to 55 years with asthma exacerbation requiring hospitalization.

Interventions: Inhaled flunisolide via metered-dose inhaler (250 µg per activation) eight puffs bid compared to systemic corticosteroids alone, following eight doses of IV corticosteroids.

Measurements and results: Peak expiratory flow rate (PEFR), FEV₁, and symptom scores were recorded on day 1 (at presentation to the emergency department) and day 7, at an outpatient follow-up visit. From day 1 to day 7, mean PEFR increased from 190 to 379 L/min in the flunisolide group, and from 207 to 347 L/min in the systemic corticosteroids group (p = 0.95; 95% confidence interval [CI], - 66.3, ). Mean FEV₁ increased from 1.6 to 2.3 L in the flunisolide group, and from 1.4 to 2.1 L in the systemic corticosteroids group (p = 0.33; 95% CI, - 21.7, ). Changes in symptom scores were - 0.7 in the flunisolide group and - 0.9 in the systemic corticosteroids group (p = 0.39; 95% CI, - 0.4, ). Hospital readmission rates on day 7 were zero for both groups.

Conclusions: High-dose inhaled corticosteroids are as effective as systemic corticosteroids during a 7-day period following admission to the hospital for severe asthma.

Key Words: acute asthma • asthma exacerbation • corticosteroids • emergency department • flunisolide • glucocorticoids • hospitalization • inhaled corticosteroids • severe asthma

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