High-dose inhaled budesonide may substitute for oral therapy after an acute asthma attack

Patients attending the emergency room with acute asthma, participating in a study comparing salbutamol (albuterol in the United States) via a dry powd er inhaler (Turbuhaler(R)) with pressurized metered-dose inhaler (pMDI), we re included in this 1-week follow-up study with the aim of assessing whethe r inhaled budesonide via Turbuhaler may be an alternative to prednisolone t ablets after an acute asthma attack. Eighty-one patients with a mean age of 38 years and forced expiratory volume in 1 sec (FEV1) of 64% predicted nor mal value after treatment with salbutamol were randomized in this double-bl ind, double-dummy, parallel-group study. The doses given were budesonide 16 00 mu g b.i.d. or prednisolone in daily doses from 40 mg (day 1) decreased to 5 mg (day 7). FEV1 was recorded before and after the 7-day treatments an d peak expiratory flow (PEF) morning and evening, clinical symptoms (visual analogue scale 0-100), and doses of rescue medication (terbutaline Turbuha ler 0.25 mg/ dose) were recorded daily. The mean increase in FEV, from base line to day 7 was 17.3% in the budesonide Turbuhaler group and 17.6% in the prednisolone group. Mean values of morning PEF increased from day 1 to day 7 by 67 L/min in the budesonide Turbuhaler group and by 57 L/min in the pr ednisolone group (not significant). There were no statistically significant differences between the groups in clinical symptoms and in the number of d oses of rescue medication. Because of disease deterioration, five patients in the Turbuhaler group and three in the prednisolone group needed addition al symptomatic as well as corticosteroid treatment. Inhaled budesonide in h igh doses may be a substitute for oral therapy as follow-up treatment after an acute asthma attack.