Corticosteroids have been used as drug treatment for some time. Lewis Sarett of Merck & Co. was the first to synthesize cortisone, using a complicated 36-step process that started with deoxycholic acid, which was extracted from ox bile .  The low efficiency of converting deoxycholic acid into cortisone led to a cost of US $200 per gram. Russell Marker , at Syntex , discovered a much cheaper and more convenient starting material, diosgenin from wild Mexican yams . His conversion of diosgenin into progesterone by a four-step process now known as Marker degradation was an important step in mass production of all steroidal hormones, including cortisone and chemicals used in hormonal contraception .  In 1952, . Peterson and . Murray of Upjohn developed a process that used Rhizopus mold to oxidize progesterone into a compound that was readily converted to cortisone.  The ability to cheaply synthesize large quantities of cortisone from the diosgenin in yams resulted in a rapid drop in price to US $6 per gram, falling to $ per gram by 1980. Percy Julian's research also aided progress in the field.  The exact nature of cortisone's anti-inflammatory action remained a mystery for years after, however, until the leukocyte adhesion cascade and the role of phospholipase A2 in the production of prostaglandins and leukotrienes was fully understood in the early 1980s.
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.