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Clinical efficacy of nebulized drugs
1Department of Paediatrics, State University Hospital, Copenhagen, Denmark.
Insights
Nebulized budesonide effectively treats asthma in children, showing dose-dependent improvements in lung function and symptoms. This method offers a viable alternative for managing pediatric asthma, particularly for steroid-dependent cases.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
Background:
- Recurrent wheezing affects 15-20% of young children.
- Many children with recurrent wheezing respond well to beta2-agonists and topical steroids, suggesting an asthma component.
- Optimal dosing of topical steroids is crucial for effective treatment.
Purpose of the Study:
- To evaluate the efficacy of nebulized budesonide in young children with asthma.
- To compare nebulized budesonide administration with metered-dose inhaler (MDI) delivery.
- To assess the dose-dependent effects and potency of nebulized budesonide.
Main Methods:
- Studies involved budesonide suspension delivered via nebulizer versus MDI with a spacer.
- Peak expiratory flow measurements and symptom scoring were used for evaluation.
- Dose-dependent effects were assessed in adult and pediatric asthma populations.
Main Results:
- Nebulized budesonide showed a dose-dependent effect, comparable in potency to MDI in adults.
- Continuous nebulization in schoolchildren demonstrated dose-dependent lung function and symptom improvement.
- Nebulized budesonide was ineffective in children unresponsive to beta2-agonists but effective in steroid-dependent asthma.
Conclusions:
- Nebulized budesonide is effective for treating reversible asthma symptoms in children.
- Continuous nebulization of budesonide shows promise for managing pediatric asthma.
- Further research may optimize delivery and dosing for pediatric asthma management.
Abstract:
There is a mandatory need for effortless drug administration to young children since the prevalence among them of recurrent wheezing is a 15-20%. It is becoming increasingly evident that many of these children respond dramatically well to beta2-agonists and topical steroids; accordingly this sub-group of children should be treated as asthmatics. The dose of topical steroids is critical as opposed to that of beta2-agonists which are often administered in doses well above the minimal effective dose. Budesonide suspension has proven its efficacy in adults in a study of 21 patients with asthma treated with budesonide suspension delivered from a nebulizer activated during inspiration versus metered dose inhalation (MDI) via a large-volume spacer. Nebulized in this manner the suspension exhibited a dose-dependent effect, apparently equipotent to the MDI administration as evaluated from daily peak expiratory flow measurements and symptom scoring. Continuous nebulization of budesonide in 18 schoolchildren with bronchial asthma similarly showed a dose-dependent improvement of lung function and symptom score, though in a 1:2 potency ratio as compared to MDI administration, probably due to loss of nebulized aerosol during expiration. In a subsequent study of 23 young children unresponsive to beta2-agonist therapy, nebulized budesonide was without demonstrable effect. Recently, a study of 31 young children with steroid-dependent asthma demonstrated a significant improvement from continuous nebulization of budesonide 1mg twice daily. In conclusion, the efficacy of nebulized budesonide has been convincingly demonstrated in patients with reversible symptoms of asthma.(ABSTRACT TRUNCATED AT 250 WORDS)