Comparison of Nebulised Budesonide and Prednisolone in Severe Asthma Exacerbation in Adults

Higenbottam, Tim; Britton, John; Lawrence, David; Connolly, C K; Harrison, N K; Eastham, Helen M.

doi:10.2165/00063030-200014040-00004

Cited by 17 publications

(12 citation statements)

References 5 publications

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“…Two studies 43,44 have compared nebulized budesonide given in repeated high doses with oral steroids in adults with severe acute asthma undergoing treatment in the emergency department (Table 2). Both studies showed no relevant difference between nebulized budesonide and oral prednisolone in terms of improvement in FEV 1 .…”

Section: Budesonide In Acute Asthma In Adultsmentioning

confidence: 99%

Inhaled budesonide in the management of acute worsenings and exacerbations of asthma: A review of the evidence

Volovitz

2007

Respiratory Medicine

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The use of systemic corticosteroids, together with bronchodilators and oxygen therapy, has become established for the management of acute asthma. These agents are undoubtedly effective, but are also associated with problems such as metabolic adverse effects. Inhaled corticosteroids (ICS) offer potential benefit in the acute setting because they are delivered directly to the airways. They are also likely to reduce systemic exposure, which would lead in turn to reductions in rates of unwanted systemic effects. In order to evaluate the role of budesonide in the management of acute asthma exacerbations we conducted a review of the literature and critically evaluated the rationale for the use of ICS in general in this setting. Trials in adults and children requiring treatment for acute exacerbation of asthma have shown clinical and/or spirometric benefit for budesonide when delivered via nebulizer, dry powder inhaler, or aerosol in the emergency department, hospital and follow-up settings. The efficacy seems to benefit from high doses given repeatedly during the initial phase of an acute exacerbation. These acute effects are likely to be linked to the drug's distinctive pharmacokinetic and pharmacodynamic profile. The current evidence base revealed encouraging results regarding the efficacy of the ICS budesonide in patients with wheeze and acute worsening of asthma. Future studies should focus on the efficacy of these agents in more severe asthma worsenings.

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Section: Budesonide In Acute Asthma In Adultsmentioning

confidence: 99%

Inhaled budesonide in the management of acute worsenings and exacerbations of asthma: A review of the evidence

Volovitz

2007

Respiratory Medicine

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“…Previous studies demonstrated the OCS-sparing efficacy of nebulised Bud and its potential advantages for treating asthma that is inadequately controlled using MDI/DPI [3,4,[13][14][15][16][17][18][19]. However, systematic OCS tapering using nebulised Bud delivered with a patient-specific, controlled inhalation manoeuvre has never been investigated.…”

Section: Introductionmentioning

confidence: 99%

Nebulised budesonide using a novel device in patients with oral steroid-dependent asthma

et al. 2014

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This phase 2/3 randomised, parallel-group, placebo-controlled trial investigated oral corticosteroid (OCS)-sparing efficacy, safety and tolerability of nebulised budesonide (Bud) administered with a novel computer-controlled, compressor-driven inhalation system (AKITA) as add-on therapy to Global Initiative for Asthma step 5.Patients (18-65 years) with OCS-dependent asthma were randomised (2:1:1:1) to receive 18-week, twicedaily, double-blind treatment with AKITA inhaled corticosteroid (AICS)-Bud 1 mg, AICS-Bud 0.5 mg, AICS-placebo or open-label Bud 1 mg administered by conventional nebuliser (CN-Bud). OCS doses were tapered until week 14.199 patients started treatment. More AICS-Bud 1 mg (80.0%) than placebo-treated (62.5%) patients had daily OCS doses reduced ⩾50%, with clinical stability to week 18 (one-sided p=0.02; treatment difference: 17.5% (95% CI 0.1-34.9%), two-sided p=0.04). Mean±SD forced expiratory volume in 1 s improved (from baseline to week 18) for AICS-Bud 1 mg (239±460 mL, p<0.001) and AICS-Bud 0.5 mg (126±345 mL, p=0.01) but not placebo (93±419 mL, p=0.36) or CN-Bud (137±459 mL, p=0.18). Fewer AICS-Bud 1 mgtreated patients experienced asthma exacerbations (7.5%) compared with placebo (17.5%) or CN-Bud (22.5%). All treatments were well tolerated.Budesonide applied with AKITA allowed significant meaningful OCS reduction in OCS-dependent asthma patients while improving pulmonary function and maintaining exacerbation control.@ERSpublications Nebulised budesonide applied with AKITA allowed significant, meaningful OCS reduction in GINA step 5 asthma patients

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“…However, the efficacy of nebulized BUD in the treatment of acute exacerbation of asthma has been addressed only in a very limited number of randomized, doubleblind, placebo-controlled studies. [13][14][15][16][17][18][19][20][21][22] In one study, Devidayal et al 21 investigated the efficacy of nebulized BUD (800 μg) versus SCS (oral prednisolone 2 mg/kg) as an add-on therapy to salbutamol (0.15 mg/kg) for the treatment of acute exacerbation of asthma in children aged 2-12 years. Both the nebulized BUD and SCS groups had marked improvement in clinical symptoms and lung function, but the improvement in clinical symptoms was greater in children treated with nebulized BUD.…”

Section: Discussionmentioning

confidence: 99%

“…BUD solution is so far the only Food and Drug Administration (FDA)‐approved nebulized ICS for children. However, the efficacy of nebulized BUD in the treatment of acute exacerbation of asthma has been addressed only in a very limited number of randomized, double‐blind, placebo‐controlled studies . In one study, Devidayal et al .…”

Section: Discussionmentioning

confidence: 99%

Effects of nebulized high‐dose budesonide on moderate‐to‐severe acute exacerbation of asthma in children: A randomized, double‐blind, placebo‐controlled study

et al. 2013

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Background and objective: The efficacy of inhaled corticosteroids (ICS) in asthma exacerbation are yet to be clarified. The aim of this study was to investigate the efficacy of nebulized ICS in children with moderate-tosevere acute exacerbation of asthma in an emergency room setting in order to elucidate the potential use of ICS as the first-line therapy in the management of acute exacerbation of asthma. Methods: This was a prospective, randomized, double-blind, placebo-controlled study. Paediatric patients with moderate-to-severe acute exacerbation of asthma in emergency room were randomized to receive nebulized salbutamol and ipratropium bromide, with the addition of nebulized high-dose budesonide (BUD group, n = 60) or normal saline (control group, n = 58), three doses in the first hour. Results: The improvement in forced expiratory volume in 1 s was similar in both groups at 0 h after three doses of nebulization, but there was significantly further improvement at 1 and 2 h in the BUD group (0.095 ± 0.062 L and 0.100 ± 0.120 L, respectively) compared with the control group (0.059 ± 0.082 L and 0.021 ± 0.128 L, respectively), P = 0.013 and 0.001, respectively. Complete remission rate was significantly higher (84.7% vs 46.3%, P = 0.004) and need for oral corticosteroids was significantly lower (16.9% vs 46.3%, P = 0.011) in BUD group than in control group. Conclusion: On the basis of nebulized short-acting bronchodilators, addition of nebulized high-dose budesonide resulted in clinical improvement in children with moderate-to-severe acute exacerbation of asthma, suggesting that nebulized high-dose ICS can be used as first-line therapy for non-life-threatening acute exacerbation of asthma in children.

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Comparison of Nebulised Budesonide and Prednisolone in Severe Asthma Exacerbation in Adults

Cited by 17 publications

References 5 publications

Inhaled budesonide in the management of acute worsenings and exacerbations of asthma: A review of the evidence

Inhaled budesonide in the management of acute worsenings and exacerbations of asthma: A review of the evidence

Nebulised budesonide using a novel device in patients with oral steroid-dependent asthma

Effects of nebulized high‐dose budesonide on moderate‐to‐severe acute exacerbation of asthma in children: A randomized, double‐blind, placebo‐controlled study

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