RESUMO
BACKGROUND: Systemic corticosteroids are routinely used in the management of acute asthma, however the optimum route of administration for patients requiring hospitalisation is unclear. Intravenous (IV) corticosteroids are used in practice, but they may not offer any advantage over oral corticosteroids. AIM: To compare the efficacy of oral and IV administration of corticosteroids in the treatment of adults hospitalised with acute asthma. METHOD: Adults admitted to hospital for treatment of acute asthma were randomised to receive oral prednisolone 100 mg once daily or hydrocortisone 100 mg IV 6 hourly for 72 h following admission. All patients concurrently received inhaled corticosteroids and bronchodilators. Improvements in peak expiratory flow rate (PEF) from baseline were compared for 72 h. RESULTS: Forty-seven patients were randomized, 30 females, 17 males. Twenty-four received oral prednisolone and 23 received IV hydrocortisone. At baseline the oral and IV groups were similar (mean, SD) in age (38.3, 12.8 vs 37.3, 12.9, P=0.80) and initial percent predicted (PP) PEF (61, 16.7 vs 69, 13.0, P=0.11). After 72 h both groups had similar improvements in PEF (27%, 26 vs 27%, 19, P=0.96). CONCLUSION: Corticosteroids administered orally and IV had similar efficacy in the treatment of adults hospitalised with acute asthma.
Assuntos
Anti-Inflamatórios/uso terapêutico , Asma/tratamento farmacológico , Glucocorticoides/uso terapêutico , Hidrocortisona/uso terapêutico , Prednisolona/uso terapêutico , Administração Oral , Adulto , Anti-Inflamatórios/administração & dosagem , Método Duplo-Cego , Feminino , Fluxo Expiratório Forçado/efeitos dos fármacos , Glucocorticoides/administração & dosagem , Hospitalização , Humanos , Hidrocortisona/administração & dosagem , Injeções Intravenosas , Tempo de Internação , Masculino , Prednisolona/administração & dosagemRESUMO
We describe the case of a heavy marijuana and tobacco smoker who presented with progressive exertional dyspnea of 2 months' duration, and bilateral nodular lung infiltrates. Examination of the lung fields was normal, and lung function tests showed mild airflow obstruction with moderately reduced gas transfer. BAL returned green-black fluid consisting predominantly of macrophages laden with carbon pigment. Thoracoscopic lung biopsy showed miliary necrotizing granulomata with an alveolar exudate of carbon-laden macrophages within macroscopically blackened lung. The differential diagnosis of pulmonary granulomata in this patient is discussed.
