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Corticosteroids administered by nebulization to children with bronchial asthma
C Terzano1, L Barkai, G Cremonesi
1University La Sapienza, Lung Unit, Rome, Italy.
Insights
Nebulized flunisolide and budesonide are effective for childhood asthma control, showing similar clinical responses. Flunisolide uniquely reduced nocturnal awakenings, with both options demonstrating good safety profiles.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
Background:
- Inhaled corticosteroids are standard for pediatric asthma management.
- Nebulization offers an alternative administration route for children with coordination difficulties.
Purpose of the Study:
- To compare the efficacy and safety of nebulized flunisolide versus budesonide in children with mild to moderate asthma.
- To evaluate the impact on asthma control, rescue medication use, and nocturnal awakenings.
Main Methods:
- A randomized trial involving 133 children (6-14 years) with asthma.
- Participants received either flunisolide (500 mcg) or budesonide (500 mcg) via nebulizer twice daily for 4 weeks.
- Primary endpoint was morning peak expiratory flow rate; secondary endpoints included rescue medication use, asthma scores, and nocturnal awakenings.
Main Results:
- Both flunisolide and budesonide significantly improved peak expiratory flow rate and reduced asthma scores and rescue salbutamol use compared to baseline.
- No significant difference was observed between flunisolide and budesonide for primary efficacy endpoints.
- Flunisolide significantly reduced nocturnal awakenings, while budesonide did not.
- Adverse events were mild and comparable between groups, with no treatment discontinuations.
Conclusions:
- Nebulized corticosteroids, including flunisolide and budesonide, are effective and well-tolerated for managing mild to moderate asthma in children.
- Flunisolide and budesonide demonstrate comparable clinical efficacy, with flunisolide showing an additional benefit in reducing nocturnal awakenings.
Abstract:
Inhaled corticosteroids are recommended for long-term control of asthma in children, and nebulization simplifies administration to patients who lack hand-to-lung coordination. Information on the efficacy and safety of nebulized corticosteroids in children with mild to moderate asthma is limited, however, and comparison between corticosteroids is lacking. One hundred thirty-three patients 6 to 14 years of age with bronchial asthma were randomly assigned to receive flunisolide 500 microg or budesonide 500 microg, both administered twice daily by nebulizer for 4 weeks. Morning peak expiratory flow rate (primary efficacy endpoint) increased significantly from baseline (P<.001) with both medications (P = NS between treatments). Use of salbutamol as rescue medication decreased by 82.6% with flunisolide and by 82.7% with budesonide; respective decreases in asthma score were 78.8% and 82.3% (P<.001 vs baseline, P = NS between treatments). Only flunisolide reduced the number of nocturnal awakenings (P<.001). Ten patients in the flunisolide group and 12 in the budesonide group reported adverse events, none of which required discontinuation of treatment. In children with asthma, nebulized corticosteroids are effective and have good safety and tolerability profiles. Flunisolide and budesonide seem to produce equivalent clinical responses.