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Practical considerations of nebulized corticosteroid in children with acute asthmatic exacerbation: A consensus
Chalerat Direkwattanachai1, Chalermthai Aksilp2, Pantipa Chatchatee3
1Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Nebulized corticosteroids, particularly budesonide, are effective for treating acute asthma exacerbations in children across all severity levels. This approach can reduce hospital admissions and improve clinical outcomes, offering a practical therapeutic option.
Area of Science:
- Pediatric Respiratory Medicine
- Clinical Pharmacology
- Evidence-Based Medicine
Background:
- Acute asthmatic exacerbations in children incur significant economic costs.
- Current guidelines offer limited practical advice on nebulized corticosteroid use for pediatric asthma exacerbations.
Purpose of the Study:
- To review and recommend practical considerations for using nebulized corticosteroids in children with acute asthmatic exacerbations.
- To provide evidence-based guidance for clinicians managing pediatric asthma emergencies.
Main Methods:
- Consensus development by expert pediatricians in respiratory and allergy fields.
- Systematic review of published English-language studies, including randomized controlled trials and meta-analyses.
- Inclusion criteria focused on children aged 1-18 years with asthmatic exacerbations treated with nebulized corticosteroids.
Main Results:
- 13 randomized controlled trials published between 1998 and 2017 were analyzed.
- Nebulized corticosteroids significantly reduced admission rates in mild to severe exacerbations compared to placebo.
- Improvements were observed in clinical scores, reduced need for systemic corticosteroids and bronchodilators, and shorter emergency room stays.
- Budesonide was the most frequently studied nebulized corticosteroid (92.31%).
Conclusions:
- Nebulized corticosteroids represent an effective treatment option for acute asthma exacerbations in children of all severities.
- Nebulized budesonide is identified as the preferred corticosteroid for this indication.
- This approach offers a practical and beneficial therapeutic strategy for pediatric asthma management.
Background:
Acute asthmatic exacerbation in children causes economic burdens both directly and indirectly. The GINA guideline does mention the use of inhaled or oral corticosteroids in the treatment of asthmatic exacerbation, it provides little practical guidance on the use of nebulized corticosteroid.
Objective:
To review and recommend the practical considerations in the use of nebulized corticosteroid in children with acute asthmatic exacerbation.
Methods:
This consensus was developed by a group of expert pediatricians in respiratory and allergy fields in Thailand. The recommendations were made based on a review of published studies and clinical opinions. The eligible studies were confined to those published in English, and randomized controlled trials and meta-analyses involving nebulized corticosteroids in asthmatic exacerbation in children aged between 1-18 years.
Results:
There were 13 randomized controlled-trial studies published from 1998 to 2017. Nine of the 13 studies compared nebulized with systemic corticosteroid conducted in moderate to severe exacerbation, while the remaining four compared nebulized corticosteroid with placebo conducted in mild to severe exacerbation. The admission rate was significantly lower in severe exacerbation (one study) and pooled four mild to severe exacerbation studies comparing with placebo (p 0.022). Other clinical parameters were significantly improved with nebulized corticosteroid such as clinical scores, systemic corticosteroid/bronchodilator use, or shorter ER stays. Only one study used fluticasone, while the other 12 studies conducted by budesonide (92.31%).
Conclusions:
Nebulized corticosteroid may offer an effective therapeutic option for the management of acute exacerbation of asthma in all severities. Nebulized budesonide is the preferred corticosteroid.
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