Comparative efficacy of intravenous methylprednisolone versus intravenous hydrocortisone in acute severe asthma

ABSTRACT

To compare the efficacy of intravenous methylprednisolone versus intravenous hydrocortisone in acute severe asthma It was a quasi-experimental interventional study, conducted on 60 patients of acute severe asthma, presenting to the emergency department of MH Rawalpindi. Military Hospital Rawalpindi from Jan 2001 to Dec 2002. Patients fulfilling the criteria were divided into two groups of 30 patients each by convenience sampling. Group-I received intravenous methylprednisolone sodium succinate 125 mg as a single dose within half an hour of admission while group-2 received intravenous hydrocortisone 200 mg bolus followed by three doses of 100mg at six hours interval for next 24 hours. In addition, both the groups received nebulized salbutamol 2.5 mg diluted with 5 ml of distilled water at an interval of 30 minutes for first hour then 4 hourly along with oxygen at a rate 4-5 liters /minutes. Pulse rate and peak expiratory flow rate [PEFR best of three attempts] were recorded on admission and subsequently at interval of six, twelve, eighteen and twenty-four hours of admission. Significant improvement in pulse rate was defined as its fall below 100 per minute and that of PEFR as its rise above 65% of predicted. Out of sixty patients, 41 were males and 19 were females. Their mean age was 38 years [range 19-50 years]. Significant improvements in pulse rate and PEFR were noted at interval of 24 hours in both groups, and this improvement was more marked in gropu-2. Target reduction [< 100/minute] in mean pulse rate was seen in 70% of patients in group-2 versus 26.7% in group-1. Target mean PEFR [> 65% of predicted] was achieved in 86.7% [group-2] and 40% [group-1]. The differences of mean pulse rate and PEFR at 24 hours were statistically significant. Intravenous hydrocortisone is more effective than intravenous methylprednisolone, at the dosages selected, in setting of acute severe asthma