RISK-FACTORS FOR HYDROCORTISONE MYOPATHY IN ACUTE SEVERE ASTHMA

In one hospital over a 15-month period, four out of nine patients ventilated for acute severe asthma developed acute hydrocortisone myopathy. All patients had received less than 1·0 g day−1 hydrocortisone. Affected patients had severe generalized weakness which recovered over 1–6 weeks. When myopathic and unaffected subjects were compared, there was no clearcut difference with respect to age, sex, types of drug used, serum potassium levels, duration of ventilation and muscles paralysis, total dose of vacuronium bromide, or mean daily doses of hydrocortisone. The main difference between the two groups was in the total doses of hydrocortisone. The myopathic patients all received >5·0 g hydrocortisone (range 5·4–10·2g) and the others <4·0 g (range 0·9–3·5 g). The possibility that neuromuscular blockade might predispose to the development of myopathy is discussed. Hydrocortisone myopathy can occur when <1·0 g day−1 is used, an even with as little as 5·4 g given over 6 days. © 1990, Baillière Tindall. All rights reserved.