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

Abstract

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.

Allergic lung inflammation promotes atherosclerosis in apolipoprotein E-deficient mice

“…33,34 Yet evidence suggests corticosteroids produce hyperlipidemia, hypertension, and dyslipidemia, which in turn may increase adverse cardiovascular events. 40,41 Conflicting case-control studies suggest an insignificant effect of corticosteroid on plasma lipid profiles.…”

Signs and Symptoms that Precede Wheezing in Children with a Pattern of Moderate-to-Severe Intermittent Wheezing

“…In the past two decades there have been multiple clinical trials in children targeting this aim[11–20]. These trials have used a variety of different approaches to trigger initiation of study intervention such as “first sign of an attack”[11]; “onset of upper respiratory tract symptoms which typically precipitated asthma attacks”[12]; “first sign of upper respiratory tract infection”[16]; and “increased in symptom scores by one point in a symptom scale”[19].…”

Guideline for the management of acute asthma in children: 2013 update

“…Maintenance doses of ICS should be continued or started as soon as possible to form the basis of the chronic asthma management plan, and to allow the educational process regarding controller therapy to start even while the patient is hospitalised. [6,[44][45][46][47][48] …”