Efficacy of nebulized budesonide compared to oral prednisolone in acute bronchial asthma

To evaluate the efficacy of nebulized budesonide compared to oral prednisol one early in the emergency room management of acute asthma, we conducted a double-blind, placebo-controlled trial. Eighty children, 2 years to 12 year s of age, with acute moderate attacks of asthma, were randomized into two g roups. One group received nebulized salbutamol (0.15 mg/kg) and placebo at half-hourly intervals for three doses, and a single dose of oral prednisolo ne (2 mg/kg) (prednisolone group) and other group received three doses of n ebulized salbutamol and budesonide (800 mu g) at half-hourly intervals and a single dose of placebo tablets (budesonide group). The baseline character istics of the two groups were similar, but after three doses of nebulizatio n oxygen saturation, respiratory rate, pulmonary index and respiratory dist ress score were significantly improved in the budesonide group compared to prednisolone group (p < 0.01). The proportion of patients who were fit for discharge at the end of 2 h after the third dose of nebulization was signif icantly higher in the budesonide group than in the prednisolone group (22/4 1, 54% vs 7/39, 18%, p < 0.001). The data suggest that a combination of neb ulized salbutamol and budesonide should be preferred in the emergency room management of children with acute moderate to severe exacerbation of asthma and who are not on prior oral or inhaled steroid therapy.