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

Abstract

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.

The Addition of Inhaled Budesonide to Standard Therapy Shortens the Length of Stay in Hospital for Asthmatic Preschool Children: A Randomized, Double-Blind, Placebo-Controlled Trial

“…While daily ICS use for asthma prophylaxis is common, several authors recommend ICS for the management of acute exacerbations [13,14,15], having assessed their efficacy in the ED setting. Recently, Chen et al [16] demonstrated that the use of nebulized corticosteroids (1,500 µg) in the first hour of ED presentation facilitated better clinical healing than when placebo was administered to patients experiencing a moderate-to-severe asthma exacerbation. This study demonstrated that early use of ICS may prove efficient in the ED treatment of asthma exacerbation.…”

Effects of nebulized amphotericin B and budesonide inhalation for chronic cough-related laryngeal sensations

“…A single dose of inhaled corticosteroid has been reported to have beneficial effects on airway inflammation and airway hyperresponsiveness as early as 6 h after dosing [18]. On the other hand, a significant increase in PEFR 2 h after inhalation of 100 mg of budesonide in asthma patients [19] and a significant improvement in forced expiratory volume in 1 s (FEV1) 1 h after administration of 0.05% budesonide (2 mL) have already been reported [20]. It is noteworthy that our results demonstrated the possibility of more rapid suppression by budesonide inhalation against the laryngeal sensation of SIT 60 min after inhalation.…”

ReCOMmendations for management of Preschool ASthma for General Practitioners – COMPAS GP

“…Istotną rolę w leczeniu odgrywa tlenoterapia, któ-rą należy wdrożyć przy podejrzeniu hipoksemii na każdym etapie postępowania celem osiągnięcia/ /utrzymania SpO 2 co najmniej powyżej 92% (docelowo: 94-98%) [1,17]. 2.…”