Corticosteroids administered by nebulization to children with bronchial asthma

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.