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ORIGINAL CONTRIBUTION |
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| Year : 2000 | Volume
: 54
| Issue : 9 | Page : 384-387 |
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Effect of single dose of prednisolone on hospitalisation in patients of acute bronchial asthma
SM Mahakalkar1, Sunita Tibdewal1, BP Khobragade2
1 Department of Pharmacology, Indira Gandhi Medical College, Nagpur 18, India
2 Department of Paediatrics, Indira Gandhi Medical College, Nagpur 18, India
Correspondence Address:
S M Mahakalkar
Department of Pharmacology, Indira Gandhi Medical College, Nagpur 18
India
PMID: 11966062
How to cite this article:
Mahakalkar S M, Tibdewal S, Khobragade B P. Effect of single dose of prednisolone on hospitalisation in patients of acute bronchial asthma. Indian J Med Sci 2000;54:384-7 |
How to cite this URL:
Mahakalkar S M, Tibdewal S, Khobragade B P. Effect of single dose of prednisolone on hospitalisation in patients of acute bronchial asthma. Indian J Med Sci [serial online] 2000 [cited 2013 May 22];54:384-7. Available from: http://www.indianjmedsci.org/text.asp?2000/54/9/384/12045 |
Traditionally, symptomatic control of bronchoconstriction with β2agonist has been the mainstay of therapy. [1] However, with growing awareness that asthma is an inflammatory condition, the paradigm of asthma medication is shifting to use of anti-inflammatory agents. Glucocorticoids are potent anti-inflammatory agents available for the treatment of asthma. Their efficacy is related to many factors including a diminution in inflammatory cell function and activation, stabilisation of vascular leakage, a decrease in mucus production, and an increase in β-ardrenergic response. [2] Patients of asthma frequently require hospitalisation. Despite advances in bronchodila for therapy, the admission rate continues to rise. Various authors [3],[4],[5],[6] have reported that stat dose of steroids given to patients of acute bronchial asthma reduces the rate of hospitalisation. There have been studies reporting combination of corticosteroids with bronchodilator as more beneficial than bronchodilators alone. The present study was undertaken to assess the effect of stat dose of oral prednisolone on rate of hospitalisation in patients of acute bronchial asthma.
| ¤ Materials and Methods | |  |
The inclusion criteria required patients (aged 1-65 years) presenting with history of cough, breathlessness associated with wheezing and respiratory rate more than 30 breaths/minute. Patients who had chronic respiratory illness like bronchiectesis, pulmonary tuberculosis or history suggestive of foreign body aspiration, pregnant patients and patients taking regular bronchodilator drugs for chronic asthma were excluded from the study.
A total of 259 patients attending casualty or out patient department at Indira Gandhi Medical College and Hospital for acute exacerbation of bronchial asthma over a period of 14 months were assigned in a randomised double blind fashion to receive a stat dose of oral prednisolone (30 mg if age <5 years or 60 mg if age >5 years) or equivalent placebo. [3],[6] after base line investigations. All patients were then given nebulised salbutamol (0.15 mg 1 Kg/dose) in 2 m/l normal saline for 5-10 minutes. Same treatment was repeated after 20 minutes for 2 more doses if patients did not respond. [1] No other medication was allowed during the study. All clinical parameters pulse, respiratory rate, blood pressure, wheezing and retraction and peak expiratory flow rate were repeated at one and four hours of therapy. After total observation period of 4 hours, hospitalisation if any was noted. The clinical criteria for hospitalisation included tachypnoea > 30 breaths/ min, tachycardia > 120 beats/min, accessory muscle use, silent chest or feeble respiratory ecort, cyanosis, bradycardia, hypotension, confusion or coma while laboratory criteria were PEFR <60% of percent predicted PEFR, PaO 2 < 80 mmHg, PaCO 2 >45 mmHg and O 2 saturation <90%. [7]
All patients gave informed written consent and the study was approved by the ethical committee of the institution. Paired student 't' test for parameteric data and chisquare test for non-parametric data was used for statistical analysis.
| ¤ Results | | |
Of the 259 patients of acute bronchial asthma, 135 (52.12%) were males and 124 (47.78%) were females [Table 1] shows the effect of single dose of oral prednisolone after reexamination at 4 hours of therapy. Though, clinically there was improvement in patients of both the groups, only 37 (26.42%) patients given prednisclone and 50(42.01%) patients given placebo required hospialisation and further management (p <0.01, x 2 = 7.0007 [Table 1]).
| ¤ Discussion | | |
The present study was undertaken to assess the effect of single dose of oral prednisolone along with routine bronchodilators, on rate of hospitalisation in patients of acute bronchial asthma. The results showed that clinical parameters indicative of severity of asthma improved in both the groups. But, the number of patients requiring hospitalisation and further management were significantly (p<0.01) less in prednisolone group compared to placebo group. This suggests that subjective decision of "fitness for discharge" significantly favours prednisolone use. Similar observation has been reported. [3],[4]
In acute exacerbation of bronchial asthma the severity of symptoms and response to therapy depends on differential contribution of bronchospasm versus other pathophysiological constituents of inflammation, for example, mucosal sloughing, bronchial oedema and accumulation of secretions within the airway lumen. Corticosteroids are potent anti-inflammatory agents and also are said to restore the bronchial hyperresponsiveness to β-adrenergic agonist. Several mechanisms may be involved such as increased agonist binding, decreased receptor turnover, increased uncoupling between receptor and adenyl cyclase, decreased extraneuronal uptake and decreaseed catechol . O- methyl transferase activity. [8] This suggests that combination of drugs which relieves bronchospasm and controls inflammation might be more useful than single drug during the acute attack of asthma. [9] In the present study also beneficial effects of steroids along with bronchodilators has been observed and it is concluded that the prompt use of single oral dose of prednisolone can significantly reduce morbidity and need for hospital admission in patients of acute bronchial asthma.
| ¤ Summary | | |
The present study was undertaken to assess the effect of stat dose of oral prednisolone on rate of hospitalisation in patients of acute bronchial asthma. 259 patients, aged 1-65 years presenting with acute exacerbation of asthma were randomised in a double blind fashion to receive a stat dose of oral prednisolonev (30 mg if age <5 years; 60mg if age > 5 years) or equivalent placebo. Then, nebulbutamol (0.15 mg/kg in 2m/l normal saline) was given to all patients and patients were re-examined after 4 hours to decide about the hospitalisation.
The study revealed that only 37 (26.42%) patients required hospitalisation and further management in prednisolone group compared to 50 (42.01%) patients in placebo group (p<0.01). This suggests that prompt use of single oral dose of prednisolone along with routine bronchodilator therapy can significantly reduce morbidity and need for hospital admission in patients of acute bronchial asthma.
| ¤ References | | |
| 1. | McFadden ER. Asthma. Harrison's Principles of internal medicine, Volume II, 13th edition, Issel-bacher KJ, Braunwald E, eds Mc Graw Hill Inc., 1994;1167-1172.  |
| 2. | Lemanske RE, Busse WW. Asthma. JAMA, 1997;278:1855-1873. |
| 3. | Storr J, Barry W, Barrel E, Lenney W, Hatcher G. Effects of a single oral dose of prednisolone in acute childhood asthma. Lancet 1987;1: 879-882. |
| 4. | Chapman KR, Verbeek PR, White JG, Rebuck AS. Effect of a short course of prednisone in the prevention of early relapse after the emergency room treatment of acute asthma. N Engl J Med 1997: 324.788-794. |
| 5. | Wolfson DH, Nypaver MM, Blaser M, Hogan A, et al. A controlled trial of methyl prednisolone in the early emergency department treatment of acute asthma in children. Paediatr Emerg Care, 1994;10:335-338. |
| 6. | Connet GJ, Warde C, Wooler E, Lezmey W. Prednisolone and salbutamal in the hospital treatment of acute asthma. Arch Dis Child 1994;70:170-173. |
| 7. | Abou Shala N, Maclntyre N. Emergent Management of Acute Asthma. Med Clin North America, 1996:80: 677-699. |
| 8. | Pauwels R. Effect of corticosteroids on action of sympathomimetics. Bull Eur Physiopathol Respir 1985: 21:53s-55s. |
| 9. | Pedersen S, Hansen OR Budesonide treatment of moderate and severe asthma in children : a dose - response study. J Allergy Clin Immunol 1995;95:29-33. |
[Table 1]
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| Fitzgerald JM | | AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE. 2003; 167 (4): 488-489 | | [Pubmed] | |
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