Corticosteroids in asthma.

Corticosteroids have a definite role in acute and chronic asthma therapy. The benefits of intravenously administered corticosteroids in acute asthma have been shown in many randomized and nonrandomized trials. Indications for corticosteroid use, corticosteroid preparation used, dosage, frequency of administration, and duration of therapy differ in every study. Analysis of these studies suggests that hydrocortisone (4 mg/kg) or methylprednisolone (125 mg) as the initial dose, followed by a continuous infusion of hydrocortisone (12 mg/kg over 24 hours), or bolus injections of methylprednisolone (125 mg every 6 hours) may be the most appropriate corticosteroid therapy in acute asthma. Methylprednisolone may have some pharmacologic advantages over hydrocortisone. A clinical approach to tapering of corticosteroids after treatment of an acute exacerbation is outlined. Hypothalamic-pituitary-adrenal-axis suppression with chronic oral and inhaled corticosteroid use and the management of corticosteroid therapy in such patients are discussed. Inhaled corticosteroids are extremely useful in management of asthma poorly controlled with bronchodilators, and physicians may consider adding them to bronchodilators from the earliest phases of therapeutic intervention for adult asthma. A practical guide to the use of inhaled corticosteroids in asthma is presented.