High-dose intramuscular triamcinolone in severe, chronic, life-threatening asthma

Raja G. Ogirala, Thomas K. Aldrich, David J. Prezant, Mark J. Sinnett, Jay B. Enden, M. Henry Williams

Research output: Contribution to journalArticle

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Abstract

Background. Despite oral corticosteroid therapy, some patients with asthma have frequent exacerbafions requiring emergency room visits, hospitalization, and occasionally, mechanical ventilation. We compared the effects of high-dose intramuscular triamcinolone with oral prednisone in patients with severe chronic asthma. Methods. In a double-blind, placebo-controlled, crossover study that spanned all seasons, we treated 12 patents with high-dose intramuscular triamcinolone (360 mg over the first three days of the treatment period) or low-dose oral prednisone (median dose, 12.5 mg per day throughout the period; range, 0 to 30). The two three-month treatment periods were separated by a three-month washout period. During all periods the patients were allowed to take additional doses of prednisone for acute exacerbations of asthma. Results. After receiving triamcinolone, the patients had significantly better peak expiratory flow rates than while receiving prednisone (the average [±SEM] weekly percent of the predicted value during the triamcinolone period was 91.5±6.9, as compared with 75.0±5.9 for the prednisone period; P<0.05). During the prednisone period there were 21 emergency room visits and 10 hospitalizations, but there were none during the triamcinolone period (P<0.05). There were two episodes of ventilatory failure during the prednisone period. Total steroid doses were significantly smaller during the triamcinolone period than during the prednisone period (P<0.04). Steroidal side effects were more pronounced after treatment with triamcinolone than after treatment with prednisone (P<0.1). Conclusions. We conclude that high-dose intramuscular triamcinolone is more effective than low-dose prednisone in patients with severe, chronic, life-threatening asthma, but steroidal side effects are somewhat worse.

Original languageEnglish (US)
Pages (from-to)585-589
Number of pages5
JournalNew England Journal of Medicine
Volume324
Issue number9
StatePublished - Feb 28 1991

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Triamcinolone
Prednisone
Asthma
Hospital Emergency Service
Hospitalization
Therapeutics
Peak Expiratory Flow Rate
Patents
Artificial Respiration
Cross-Over Studies
Adrenal Cortex Hormones
Steroids
Placebos

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Ogirala, R. G., Aldrich, T. K., Prezant, D. J., Sinnett, M. J., Enden, J. B., & Williams, M. H. (1991). High-dose intramuscular triamcinolone in severe, chronic, life-threatening asthma. New England Journal of Medicine, 324(9), 585-589.

High-dose intramuscular triamcinolone in severe, chronic, life-threatening asthma. / Ogirala, Raja G.; Aldrich, Thomas K.; Prezant, David J.; Sinnett, Mark J.; Enden, Jay B.; Williams, M. Henry.

In: New England Journal of Medicine, Vol. 324, No. 9, 28.02.1991, p. 585-589.

Research output: Contribution to journalArticle

Ogirala, RG, Aldrich, TK, Prezant, DJ, Sinnett, MJ, Enden, JB & Williams, MH 1991, 'High-dose intramuscular triamcinolone in severe, chronic, life-threatening asthma', New England Journal of Medicine, vol. 324, no. 9, pp. 585-589.
Ogirala RG, Aldrich TK, Prezant DJ, Sinnett MJ, Enden JB, Williams MH. High-dose intramuscular triamcinolone in severe, chronic, life-threatening asthma. New England Journal of Medicine. 1991 Feb 28;324(9):585-589.
Ogirala, Raja G. ; Aldrich, Thomas K. ; Prezant, David J. ; Sinnett, Mark J. ; Enden, Jay B. ; Williams, M. Henry. / High-dose intramuscular triamcinolone in severe, chronic, life-threatening asthma. In: New England Journal of Medicine. 1991 ; Vol. 324, No. 9. pp. 585-589.
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N2 - Background. Despite oral corticosteroid therapy, some patients with asthma have frequent exacerbafions requiring emergency room visits, hospitalization, and occasionally, mechanical ventilation. We compared the effects of high-dose intramuscular triamcinolone with oral prednisone in patients with severe chronic asthma. Methods. In a double-blind, placebo-controlled, crossover study that spanned all seasons, we treated 12 patents with high-dose intramuscular triamcinolone (360 mg over the first three days of the treatment period) or low-dose oral prednisone (median dose, 12.5 mg per day throughout the period; range, 0 to 30). The two three-month treatment periods were separated by a three-month washout period. During all periods the patients were allowed to take additional doses of prednisone for acute exacerbations of asthma. Results. After receiving triamcinolone, the patients had significantly better peak expiratory flow rates than while receiving prednisone (the average [±SEM] weekly percent of the predicted value during the triamcinolone period was 91.5±6.9, as compared with 75.0±5.9 for the prednisone period; P<0.05). During the prednisone period there were 21 emergency room visits and 10 hospitalizations, but there were none during the triamcinolone period (P<0.05). There were two episodes of ventilatory failure during the prednisone period. Total steroid doses were significantly smaller during the triamcinolone period than during the prednisone period (P<0.04). Steroidal side effects were more pronounced after treatment with triamcinolone than after treatment with prednisone (P<0.1). Conclusions. We conclude that high-dose intramuscular triamcinolone is more effective than low-dose prednisone in patients with severe, chronic, life-threatening asthma, but steroidal side effects are somewhat worse.

AB - Background. Despite oral corticosteroid therapy, some patients with asthma have frequent exacerbafions requiring emergency room visits, hospitalization, and occasionally, mechanical ventilation. We compared the effects of high-dose intramuscular triamcinolone with oral prednisone in patients with severe chronic asthma. Methods. In a double-blind, placebo-controlled, crossover study that spanned all seasons, we treated 12 patents with high-dose intramuscular triamcinolone (360 mg over the first three days of the treatment period) or low-dose oral prednisone (median dose, 12.5 mg per day throughout the period; range, 0 to 30). The two three-month treatment periods were separated by a three-month washout period. During all periods the patients were allowed to take additional doses of prednisone for acute exacerbations of asthma. Results. After receiving triamcinolone, the patients had significantly better peak expiratory flow rates than while receiving prednisone (the average [±SEM] weekly percent of the predicted value during the triamcinolone period was 91.5±6.9, as compared with 75.0±5.9 for the prednisone period; P<0.05). During the prednisone period there were 21 emergency room visits and 10 hospitalizations, but there were none during the triamcinolone period (P<0.05). There were two episodes of ventilatory failure during the prednisone period. Total steroid doses were significantly smaller during the triamcinolone period than during the prednisone period (P<0.04). Steroidal side effects were more pronounced after treatment with triamcinolone than after treatment with prednisone (P<0.1). Conclusions. We conclude that high-dose intramuscular triamcinolone is more effective than low-dose prednisone in patients with severe, chronic, life-threatening asthma, but steroidal side effects are somewhat worse.

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