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October 6, 1989

Immunotherapy and Asthma

JAMA. 1989;262(13):1772. doi:10.1001/jama.1989.03430130046020

To the Editor. —  The article by Ratto et al1 addresses the important issue of cost-effective use of corticosteroids in asthmatic patients. The improvement in airflow in both the orally and intravenously administered methylprednisolone groups is impressive. Their study does, however, raise several issues.First, should every patient requiring treatment for acute bronchoconstriction receive oral medications? Although the patients in this study were acutely ill, as judged by the forced expiratory volume in 1 second percent predicted, all responded dramatically within 18 hours. If a patient with status asthmaticus should present in a shocklike state, perfusion of peripheral vascular beds, including the gastrointestinal tract, may be altered.2 Absorption of orally administered medications would therefore be expected to be abnormally low, and intravenous drug administration might be expected to be more effective.Second, what was the inciting event causing the bronchoconstriction? If a bacterial bronchitis was involved in the