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Efficacy of nebulized budesonide compared to oral prednisolone in acute bronchial asthma
1Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Insights
Nebulized budesonide with salbutamol significantly improved asthma symptoms in children compared to oral prednisolone. This combination therapy leads to faster recovery and higher discharge rates in the emergency room setting.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Clinical Pharmacology
Background:
- Acute asthma exacerbations in children require effective emergency room management.
- Current treatments often involve oral corticosteroids and bronchodilators, but their early efficacy can vary.
- Optimizing early interventions is crucial for reducing hospital stays and improving patient outcomes.
Purpose of the Study:
- To compare the efficacy of nebulized budesonide versus oral prednisolone in the early management of acute moderate asthma attacks in children.
- To evaluate the impact of these treatments on respiratory parameters and patient disposition.
Main Methods:
- A double-blind, placebo-controlled trial involving 80 children (2-12 years) with moderate asthma exacerbations.
- Participants received either nebulized salbutamol with oral prednisolone or nebulized salbutamol with nebulized budesonide.
- Outcomes assessed included oxygen saturation, respiratory rate, pulmonary index, respiratory distress score, and discharge readiness.
Main Results:
- The budesonide group showed significant improvements in oxygen saturation, respiratory rate, pulmonary index, and respiratory distress score compared to the prednisolone group (p < 0.01).
- A higher proportion of patients in the budesonide group (54%) were ready for discharge within 2 hours compared to the prednisolone group (18%) (p < 0.001).
Conclusions:
- Nebulized budesonide in combination with salbutamol is more effective than oral prednisolone for the early emergency room management of acute moderate to severe asthma exacerbations in children not on prior steroid therapy.
- This therapeutic approach offers a superior alternative for improving clinical status and facilitating earlier discharge.
Abstract:
To evaluate the efficacy of nebulized budesonide compared to oral prednisolone early in the emergency room management of acute asthma, we conducted a double-blind, placebo-controlled trial. Eighty children, 2 years to 12 years of age, with acute moderate attacks of asthma, were randomized into two groups. One group received nebulized salbutamol (0.15 mg/kg) and placebo at half-hourly intervals for three doses, and a single dose of oral prednisolone (2 mg/kg) (prednisolone group) and other group received three doses of nebulized salbutamol and budesonide (800 microg) at half-hourly intervals and a single dose of placebo tablets (budesonide group). The baseline characteristics of the two groups were similar, but after three doses of nebulization oxygen saturation, respiratory rate, pulmonary index and respiratory distress score were significantly improved in the budesonide group compared to prednisolone group (p < 0.01). The proportion of patients who were fit for discharge at the end of 2 h after the third dose of nebulization was significantly higher in the budesonide group than in the prednisolone group (22/ 41, 54% vs 7/39, 18%, p < 0.001). The data suggest that a combination of nebulized salbutamol and budesonide should be preferred in the emergency room management of children with acute moderate to severe exacerbation of asthma and who are not on prior oral or inhaled steroid therapy.