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The study was a randomized, double-blind, placebo-controlled trial of adult patients with severe asthma exacerbation who were admitted to the hospital for treatment. Admitted patients met criteria for hospitalization, and the decision to admit was made by a physician who was not involved in the study. All patients were treated with inhaled beta agonists every four hours as needed and with 40 mg of intravenous methylprednisolone every six hours for 48 hours. Participants were randomized to receive eight puffs of flunisolide (250 mcg per actuation) via a spacer twice daily or placebo. This therapy was initiated within 12 hours of admission. After 48 hours, the intravenous corticosteroid was discontinued, and patients began a course of therapy with oral prednisone or placebo. Patients who had received flunisolide were given placebo instead of prednisone. A follow-up visit was scheduled on day 7 of the study. Outcomes, which were measured on days 1 and 7, included peak expiratory flow rates, forced expiratory volume in one second (FEV 1 ), and symptom scores. Secondary outcome measures included hospital readmissions, emergency department revisits, and length of hospital stay.
Triamcinolone acetonide is most often used. It can be diluted with normal saline or lignocaine and is delivered in volumes of 1-2 mL. The concentration used depends on the pathology and skin site. Generally, one commences with a concentration of 5 mg/mL working up to the full concentration of 40 mg/mL, if necessary, when there is no response. If required, the injection can be repeated every 4-6 weeks. The adverse effects include pain, secondary infection, telangiectasia, leucoderma and dermal atrophy. Systemic adverse effects are rare unless large quantities are used. Intralesional steroids are not used for epidermal conditions. Care is required to introduce the steroid deep into the dermis to avoid epidermal atrophy, as well as dermal atrophy in those conditions where there is not a grossly thickened dermis. In the case of keloid, atrophy of the dermis following the use of treatment is unlikely to be a problem.