PSHP 2026 Residency Conference

This study assessed whether low-dose versus high-dose intravenous (IV) methylprednisolone may affect clinical response in emergency department (ED) patients presenting with an acute asthma or COPD exacerbation and a high eosinophil count.  


This single-center, retrospective cohort study included adult patients who presented to the ED with an acute asthma or COPD exacerbation and received IV methylprednisolone with a baseline eosinophil count greater than or equal to 3% or 300 cells/mcL. Patients were stratified into two groups, low-dose versus high-dose (< 40 mg or >40 mg of IV methylprednisolone), based on the initial dose of steroid that was administered in the ED. The primary endpoint was to compare Intensive Care Unit (ICU)-free days within a 28-day period. Key secondary endpoints measured include baseline eosinophil count, supplemental oxygen, hospital length of stay, and patient disposition. Cumulative correctional insulin use within 72 hours of initial methylprednisolone administration was evaluated as a surrogate for dose-dependent steroid-related adverse effects.  


Among 50 patients, 25 received low-dose and 25 received high-dose corticosteroids in the ED. Mean ICU-free days at 28 days were similar between groups (27.9 ± 0.34 vs 27.5 ± 1.22; p =0.577). The high-dose group had a higher baseline eosinophil count (median 6.1% [500 cells/mcL] vs 4.3% [400 cells/mcL]) and more patients on supplemental oxygen at baseline (6 vs 3). Hospital length of stay was longer in the high-dose group (4.15 vs 3.57 days; p=0.638), and more patients required ICU admission (5 vs 1 patient; p=0.172). Additionally, cumulative correctional insulin use within 72 hours was higher in the high-dose group (median 22 [IQR 2.5-50]) vs 10 [IQR 1.5-61.5]). 


Low-dose IV methylprednisolone demonstrated similar outcomes to high-dose therapy. Patients receiving higher doses appeared more clinically complex at baseline, with higher eosinophil counts and greater oxygen requirements. No significant differences in patient outcomes were observed. This study may support lower corticosteroid dosing in eosinophilic exacerbations to reduce potential steroid-related harm while maintaining clinical effectiveness.