Overview of corticosteroid therapy.

Corticosteroids have been recognized as useful in the management of asthma for the past 35 years. Controversy remains as to their precise indications, dosage, and optimal methods of administration. Only recently has objective evidence been presented confirming their usefulness in acute severe attacks and status asthmaticus. In the treatment of the latter, high doses of methylprednisolone (125 mg every 6 hours) has been shown to be more effective than lower doses. The corticosteroids are also useful diagnostically to determine reversibility of airway obstruction in the bronchitis-emphysema syndrome. To prevent adrenal insufficiency, they are mandatory for patients previously receiving long-term systemic corticosteroid therapy who are undergoing stress (e.g., surgery). Indications for chronic severe asthma are the least well established. Patients with severe incapacitating asthma uncontrolled by bronchodilators or cromolyn should be considered candidates for corticosteroid therapy. When long-term therapy is necessary, aerosolized corticosteroids or alternate-day therapy are preferable to daily dosing. Regardless of the route used, it is advisable to limit the use of these agents to patients who clearly require them and to take all precautions to minimize side effects. Neither method, especially when higher doses are used, obviates possible development of serious complications.