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Inhaled budesonide in acute asthma
S Singhi1, S Banerjee, H Nanjundaswamy
1Paediatric Emergency and Intensive Care Unit, Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India. medinst@pgi.chd.nic.in
Insights
Early aerosolized budesonide therapy in children with moderate asthma exacerbations significantly improved respiratory status and reduced hospitalizations. This treatment, combined with salbutamol, offers a promising option for early recovery and potentially home-based care.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Pharmacology
Background:
- Acute moderate exacerbations of bronchial asthma in children require effective and timely emergency room treatment.
- Current treatments may not always lead to rapid recovery or prevent hospitalization.
Purpose of the Study:
- To evaluate the efficacy of early aerosolized budesonide therapy using a metered dose inhaler and spacer in children with acute moderate asthma exacerbations.
- To assess the impact on recovery time, need for oxygen, systemic corticosteroids, aminophylline, and hospitalization.
Main Methods:
- A randomized, double-blind, placebo-controlled trial was conducted in a pediatric emergency service.
- Sixty children (3-12 years) with moderate asthma exacerbations received oxygen, nebulized salbutamol, and either aerosolized budesonide (400 mcg) or placebo via MDI and spacer every 30 minutes for three doses.
- Clinical parameters including respiratory rate, oxygen saturation, and peak expiratory flow rate were monitored hourly.
Main Results:
- The budesonide group showed greater improvements in respiratory rate and peak expiratory flow rate compared to placebo.
- Fewer patients in the budesonide group required prolonged oxygen therapy (23% vs. 50%), aminophylline infusion, or systemic corticosteroids (7% vs. 27%).
- No children in the budesonide group required hospitalization, compared to 23% in the placebo group, with a significantly shorter hospital stay (3.2 vs. 7.8 hours).
Conclusions:
- Early aerosolized budesonide therapy, administered with a metered dose inhaler and spacer alongside nebulized salbutamol, accelerates recovery and reduces the need for hospitalization in children with acute moderate asthma exacerbations.
- This regimen may be a valuable option for home-based early treatment of asthma exacerbations.
Objective:
To evaluate the efficacy of aerosolized budesonide therapy (with metered dose inhaler and spacer) early in the emergency room treatment of acute moderate exacerbations of bronchial asthma in children.
Design:
Randomized, double-blind, placebo-controlled trial.
Setting:
Paediatric Emergency Service of an urban teaching hospital and a tertiary case referral centre.
Study Population:
Sixty children between 3 and 12 years of age with an acute moderate exacerbation of asthma.
Intervention:
All patients received humidified oxygen (5-8 L/min by Venturi(R) mask; Hudson Respiratory Care, Temecula, CA, USA), nebulized salbutamol (0.15 mg/kg in 3 mL saline) and were randomized to receive either budesonide (400 microg) or placebo inhalation (MDI and spacer) at half hourly intervals for three doses. If there was an inadequate response or no response to treatment at the end of 2 h, oxygen and salbutamol therapy were continued and the patient was given one of dose intravenous hydrocortisone and was started on an aminophylline infusion. If there was no response at the end of a further 4 h, the patient was hospitalized. INITIAL EVALUATION AND MONITORING: Colour, respiratory rate (RR), heart rate, accessory muscle usage, chest retraction, wheeze, oxygen saturation (by pulse oximetery) and peak expiratory flow rate (PEFR) was recorded at admission and thereafter at hourly intervals for 3 h or until till the child recovered. The need for oxygen therapy after 2 h and need for hospitalization were recorded.
Main Results:
Both groups showed a significant improvement in respiratory status at the end of 2 h. However, children in the intervention group showed greater improvements in RR and PEFR (P < 0. 05) and respiratory distress score (P < 0.1). A significantly lower proportion of the intervention group patients required oxygen therapy for more than 2 h (23% vs 50%; P < 0.05) and aminophylline infusion and systemic corticosteroid therapy (7% vs 27%; P < 0.05). None of the children in the budesonide group, in contrast to 23% of those in the placebo group, required hospitalization (P < 0.05). The length of hospital stay (i.e. time taken to recover from acute asthma) was significantly shorter in the intervention group (3.2 +/- 2.5 h) than in the placebo group (7.8 +/- 11.3 h; P < 0.01).
Conclusion:
Aerosolized budesonide therapy (with MDI and spacer) together with nebulized salbutamol early in the emergency room treatment of acute moderate exacerbations of asthma helped in early recovery and decreased the need for hospitalization. It may be worthwhile calculating this regimen for home-based early treatment of acute exacerbations.