A randomized comparison of 100-mg vs 500-mg dose of methylprednisolone in the treatment of acute asthma.

There have been conflicting reports comparing the effects of various doses of corticosteroids in the treatment of acute asthma. The purpose of this study was to compare 100 mg with 500 mg of methylprednisolone in the emergency department treatment of acute asthma. We studied 150 patients presenting to the emergency department with acute asthma. After baseline pulmonary function testing, patients were treated with oxygen and hourly administration of aerosolized albuterol. Patients were randomized to receive either 100 or 500 mg of methylprednisolone intravenously. Spirometry was repeated at 3 h, and again at 5 h for those patients whose dyspnea had not resolved after 3 h. There was no difference in the FEV1 between the 500-mg and 100-mg dose groups either before treatment (38.0% vs 32.6% of predicted normal) or after treatment (55.3% vs 51.9% of predicted normal). There was no difference in the percentage improvement in FEV1 with treatment between the 500-mg and 100-mg dose groups (65.0% vs 71.2%). Twenty-five percent of the patients in the 500-mg dose group were admitted to the hospital compared with 28% of patients in the 100-mg dose group (not significant). We conclude that the administration of a 500-mg dose of methylprednisolone offers no advantages over a 100-mg dose in the emergency department treatment of acute asthma.