Comparison of nebulised budesonide and prednisolone in severe asthma exacerbation in adults

Background: Short courses of oral prednisolone are used as rescue therapy f or severe asthma exacerbations. This study compares nebulised budesonide or oral prednisolone, both followed by budesonide Turbohaler(R), as a treatme nt for severe asthma exacerbations, in the absence of life-threatening feat ures. Patients and Methods: Thirteen adults admitted to hospital were randomised to receive either nebulised budesonide (4mg 8-hourly) for 48 to 72 hours fo llowed by budesonide Turbohaler(R) (1600 mug twice daily for 7 days, then 8 00 mug twice daily for 21 days) for 28 days or prednisolone (40mg daily) fo r 9 to 11 days followed by budesonide Turbohaler(R) (800 mug twice daily) f or 21 days. The primary efficacy variable was the change from baseline at 4 8 hours in forced expiratory volume in 1 second (FEV1). Secondary efficacy variables included an assessment of symptom severity (0 = none, 1 = mild, 2 = moderate, 3 = severe). Results: Difficulties were experienced with patient recruitment in the emer gency setting. The results presented are from an incomplete study. Change i n FEV1 from baseline to 48 hours was not scatistically significantly differ ent between the groups (the study was underpowered to detect a difference i n change in FEV1, as the power to detect a prespecified difference between groups was 18%). Nebulised budesonide significantly reduced the severity of wheeze after 24 hours compared with prednisolone [estimate of treatment ef fect = -0.95; 95% confidence intervals (CI) = -1.76 to -0.15; p = 0.0336 be tween groups] and 48 hours (estimate of treatment effect = -0.79; 95% CI = -1.42 to -0.15; p = 0.0326 between groups). Conclusion: While oral prednisolone or intravenous hydrocortisone, oxygen a nd bronchodilators are the mainstay of acute management in severe asthma, t he results of this study suggest that nebulised budesonide may assist in re gaining control of symptoms during exacerbations of asthma.