Clinical Effectiveness Of Sequential Therapy With Methylprednisolone And Nebulised Pulmicor Respules In The Treatment Of Acute Moderate/Severe Asthma

AIM: To compare the effect of methylprednisolone and nebulised pulmicor respules in sequential therapy of acute moderate/ severe asthma.METHODS: twenty-seven patients(16-70 years) with acute moderate/ severe asthma were randomly divided into three groups:group A.B and C.Group A were treated with methylprednisolone 80 mg,iv,bid for 3d,then oral methylprednisolone was substituted 8 mg bid for 4 d;Group B were treated with methylprednisolone 80 mg,iv,bid for 3d,then nebulised pulmicor respules was substituted 2 mg bid for 4 d;Group C were treated with nebulised pulmicor respules,4mg,bid for 3d,then nebulised pulmicor respules 2 mg bid for 4 d.RESULTS: The day- and night- time asthma symptom scores decreased significantly after one day in all group (P< 0.05). Compared with the first day, the peak expiratory flow(PEF) of daytime and nighttime measurements both increased significantly(P<0.05) in group A and B in the third day, but for C group, there only existed significant difference in daytime PEF. And the results were similar in the seventh day. FEV1 % levels were increased from (48.89±22.17).(55.11±16.09)and(54.22±17.56)to(77.56±17.02).(79.33±16.09)and(74.22±24.05) when completing the treatment, there only existed significant difference in group A and B. The ACQ scores decreased significantly after seven days'treatment in all group (P< 0.01). The fractional exhaled nitricoxid(FENO) decreased at the 8th day in all group(n=14). There was a significant suppression of Plasma cortisol at the 8th day in group A (P<0.05). In group C, the patients felt discomfortable in upper airway when inhale pulmicor 4mg and sputum was increased, one of which got worse again and required additional systemic steroids.CONCLUSIONS: For acute moderate/ severe asthma, the therapy with methylprednisolone iv is more effective than nebulised pulmicor respules, as it can improve the symptoms significantly after one day and the pulmonary function after two or three days. The effects of intravenous methylprednisolone with sequential nebulised pulmicort and oral methylprednisolone are similar. and it has no influence on the hypothalamic-pituitary-adrenal axis; however, it costs a lot. The fractional exhaled nitricoxid(FENO) decreases at the 8th day in all group(n=14), which suggests that FENO be used to monitor the airway inflammation of acute asthma.