Inhaled budesonide in acute asthma

Objective: To evaluate the efficacy of aerosolized budesonide therapy (with metered dose inhaler and spacer) early in the emergency room treatment of acute moderate exacerbations of bronchial asthma in children. Design: Randomized, double-blind, placebo-controlled trial. Setting: Paediatric Emergency Service of an urban teaching hospital and a t ertiary case referral centre. Study population: Sixty children between 3 and 12 years of age with an acut e moderate exacerbation of asthma. Intervention: All patients received humidified oxygen (5-8 L/min by Venturi (R) mask; Hudson Respiratory Care, Temecula, CA, USA), nebulized salbutamol (0.15 mg/kg in 3 mt saline) and were randomized to receive either budesoni de (400 mu g) or placebo inhalation (MDI and spacer) at half hourly interva ls for three doses, if there was an inadequate response or no response to t reatment at the end of 2 h, oxygen and salbutamol therapy were continued an d the patient was given one of dose intravenous hydrocortisone and was star ted on an aminophylline infusion. if there was no response at the end of a further 4 h, the patient was hospitalized. Initial evaluation and monitoring: Colour, respiratory rate (RR), heart rat e, accessory muscle usage, chest retraction, wheeze, oxygen saturation (by pulse oximetery) and peak expiratory flow rate (PEFR) was recorded at admis sion and thereafter at hourly intervals for 3 h or until till the child rec overed. The need for oxygen therapy after 2 h and need for hospitalization were recorded. Main results: Both groups showed a significant improvement in respiratory s tatus at the end of 2 h. However, children in the intervention group showed greater improvements in RR and PEFR (P < 0.05) and respiratory distress sc ore (P < 0.1). A significantly lower proportion of the intervention group p atients required oxygen therapy for more than 2 h (23% vs 50%; P < 0.05) an d aminophylline infusion and systemic corticosteroid therapy (7% vs 27%; P < 0.05). None of the children in the budesonide group, in contrast to 23% o f those in the placebo group, required hospitalization (P < 0.05). The leng th of hospital stay (i.e. time taken to recover from acute asthma) was sign ificantly shorter in the intervention group (3.2 +/- 2.5 h) than in the pla cebo group (7.8 +/- 11.3 h; P < 0.01). Conclusion: Aerosolized budesonide therapy (with MDI and spacer) together w ith nebulized salbutamol early in the emergency room treatment of acute mod erate exacerbations of asthma helped in early recovery and decreased the ne ed for hospitalization. It may be worthwhile calculating this regimen for h ome-based early treatment of acute exacerbations.