Inhaled budesonide in acute asthma

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.