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October 6, 1989

Immunotherapy and Asthma-Reply

JAMA. 1989;262(13):1773. doi:10.1001/jama.1989.03430130046024

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In Reply.—  In our article, we tried to demonstrate that most patients with severe asthma can be managed with highdose oral corticosteroids. We do not recommend use of oral steroids initially if imminent respiratory failure or a questionable ability of the patient to absorb the medications through the gastrointestinal tract is considered.There were no statistical differences between either group as related to treatment with antibiotics, use of subcutaneous terbutaline or inhaled atropine, or prior use of steroids. Of the 11 patients who received prior steroids, 8 of them had received 10 mg or less in the prior 24 hours. The inclusion or exclusion of the remaining 3 patients, 1 of whom was in the intravenous group, did not alter the results of the study. Perhaps, as Dr Bogin pointed out, the patient who fails to respond to aggressive outpatient therapy with high-dose oral medication should receive intravenous corticosteroids. It,