Hydrocortisone and airflow impairment in aspirin-induced asthma.

We studied the effects of intravenous injection of hydrocortisone, as compared to its solvent, in 31 patients with aspirin-induced asthma. Mean FEV1 fell significantly 5 minutes after an intravenous bolus of 300 mg of hydrocortisone, but not after the solvent, and returned to the initial values 1 hour later. Only three of 31 patients displayed at this time clinical signs of increased impairment of airflow that resolved spontaneously. Neither in these three patients nor in another patient known already to respond with bronchoconstriction to 30 to 50 mg of hydrocortisone did intravenous injections of 20 mg of methylprednisolone, 4 mg of dexamethasone, or 4 mg of betamethasone produce any signs of bronchial obstruction. In the whole group of patients, mean FEV1 increased significantly 3 to 5 hours after hydrocortisone injection. It is hypothesized that hydrocortisone might induce early bronchoconstriction in patients with aspirin-induced asthma through its inhibitory effects on prostanoid biosynthesis. Use of intravenous steroids other than hydrocortisone is advisable in patients with aspirin-induced asthma.