A COMPARISON OF NEBULIZED BUDESONIDE WITH ORAL PREDNISOLONE IN THE TREATMENT OF EXACERBATIONS OF OBSTRUCTIVE PULMONARY-DISEASE

Nebulized corticosteroids in acute bronchospasm may offer topical anti -inflammatory activity while minimizing undesirable systemic effects. We compared the side-effect profile of nebulized budesonide (2 mg twic e daily) with that of oral prednisolone (30 mg once daily) in a random ized parallel-group study of 19 adults with severe acute airway obstru ction. Over the 5 days of the study, baseline forced expiratory volume in 1 second (FEV(1)) increased from 1.8 (95% confidence interval [CI] , 0.7) to 2.1 (95% CI, 0.7) L in the group that received oral corticos teroids compared with 1.9 (95% CI, 0.7) to 2.0 (95% CI, 0.7) L in the group that received nebulized corticosteroid. All biochemical variable s were similar at day 1. Comparison of budesonide treatment with predn isolone on day 5 showed that urinary corticosteroid metabolites were s ignificantly higher (2012 [95% CI, 812] compared with 1079 [95% CI, 34 6] mg/24 hr [p < 0.05]), urinary androgen metabolites were not differe nt, serum osteocalcin was elevated (2.3 [95% CI, 1.4] compared with 0. 6 [95% CI, 0.6] ng/ml [p < 0.05]), and 24-hour urinary calcium to crea tinine ratios were lower (0.28 [95% CI, 0.1] compared with 0.53 [95% C I, 0.2]), whereas urinary hydroxyproline to creatinine ratios were sim ilar. The biochemical markers associated with corticosteroid side effe cts improve in patients treated with nebulized corticosteroids compare d with patients who receive conventional treatment.