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Efficacy of nebulised budesonide versus oral prednisolone in acute severe asthma
Cuddalore Subramanian Arulparithi1, Thirunavukkarasu Arun Babu, C Ravichandran
1Department of Pediatrics, Karpaga Vinayaga Institute of Medical Sciences, Maduranthagam, Tamil Nadu, India.
Insights
Nebulised budesonide offers a superior treatment for acute severe asthma in children compared to oral prednisone. This approach significantly improves lung function and readiness for discharge within two hours.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacology
- Emergency Medicine
Background:
- Acute severe asthma exacerbations in children require prompt and effective treatment.
- Oral corticosteroids are a standard treatment, but alternative delivery methods are being explored.
- Nebulised corticosteroids offer a potential alternative for rapid symptom management.
Purpose of the Study:
- To compare the efficacy of nebulised budesonide versus oral prednisone in treating acute severe asthma in children aged 5-12 years.
- To evaluate key clinical indicators including heart rate, respiratory rate, oxygen saturation, and Peak Expiratory Flow Rate (PEFR).
- To assess the proportion of patients deemed fit for discharge after treatment.
Main Methods:
- A randomized controlled trial involving children aged 5-12 years with acute severe asthma.
- Intervention group received nebulised budesonide (800 μg) with placebo tablets.
- Control group received oral prednisolone (2 mg/kg) with placebo solution. Both groups received nebulised salbutamol.
Main Results:
- Nebulised budesonide showed a significantly greater reduction in tachycardia (p=0.0002) compared to oral prednisolone.
- Significant improvement in PEFR values (p=0.024) and a higher proportion of patients fit for discharge (p=0.0278) were observed in the budesonide group.
- Both treatments improved clinical severity scores, but budesonide demonstrated superior outcomes in specific metrics.
Conclusions:
- Nebulised budesonide is an effective alternative to oral prednisone for acute severe asthma in children.
- This treatment significantly enhances PEFR and patient readiness for discharge within 2 hours.
- Nebulised budesonide presents a promising therapeutic option for pediatric acute severe asthma management.
Objective:
To compare the efficacy of nebulised budesonide with that of oral prednisone in the treatment of acute severe asthma in children.
Methods:
Children aged 5-12 y with acute exacerbation of bronchial asthma were included. The study (budesonide) group received budesonide respirator solution (800 μg) at intervals of 20 min and a single dose of placebo tablets. The control (prednisolone) group received placebo solution at intervals of 20 min and a single dose of oral prednisolone (2 mg/kg). Both groups received three doses of nebulised salbutamol (0.15 mg/kg). Heart rate, respiratory rate, oxygen saturation, PEFR (Peak Expiratory Flow Rate) and fitness for discharge were assessed.
Results:
Both groups showed a progressive decrease in tachycardia with treatment, but it was significantly greater in study group (p = 0.0002). There was significant decrease in tachypnea and improvement in oxygen saturation in both groups, but the difference between the groups (p = 0.334 and p = 0.814 respectively) was not significant. There was significant improvement in PEFR values in budesonide group (p = 0.024). Both groups showed significant improvement in clinical severity scores at the end of 2 h (p < 0.0001). Budesonide group had significantly higher proportion of patients fit for discharge at 2 h (based on clinical severity scores) (p = 0.0278).
Conclusions:
Nebulised budesonide significantly improves PEFR levels and fitness for discharge at 2 h when compared to oral prednisolone in children between 5 and 12 y with acute severe asthma.
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