Comparison of high-dose inhaled flunisolide to systemic corticosteroids in severe adult asthma.

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 micro g per activation) eight puffs bid compared to systemic corticosteroids alone, following eight doses of IV corticosteroids. MEASUREMENTS AND RESULTS Peak expiratory flow rate (PEFR), FEV(1), 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, infinity ). Mean FEV(1) 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, infinity ). 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, infinity ). 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.