Effectiveness of inhaled corticosteroids in controlling acute asthma exacerbations in children at home

Many clinicians advise their patients to increase the dose of inhaled corti costeroids during acute asthma exacerbations, without strong clinical evide nce supporting this treatment. This study investigates the effectiveness of inhaled corticosteroids in controlling acute asthma exacerbations in child ren at home. The study population consisted of children with mild intermitt ent, mild and moderate persistent asthma aged 1 to 14 years who were treate d in our outpatient clinic with inhaled budesonide for 1 lear. After partic ipating an asthma education session, the parents were instructed to initiat e treatment with inhaled budesonide at the first signs of asthma exacerbati on, starting with 200 to 400 mug budesonide, in combination with beta-2 ago nists 4 times a. day and followed by a decrease in the dose in 4 to 8 days. Asthma status and peak expiratory flow rates were measured in the 3 monthl y follow-up visits. Only children who complied with the treatment regimen a nd came for follow-up visits regularly were included in the final analysis. One hundred fifty children used our treatment protocol with inhaled budeso nide to control their asthma attacks. Clinical improvement of asthma sympto ms was achieved after a mean of 1.8 +/- 0.7 days from the beginning of trea tment. The parents were able to control 94% of the 1,061 episodes of asthma exacerbation occur ring during a cumulative follow-up period of 239 years. In the 3-month period before emrollment, 101 children (67%) had used oral corticosteroids to control their asthma attacks and 50 (33%) were hospitali zed, During the entire follow-up period, only II children (7%) used oral co rticosteroids, and none of the children were hospitalized, The present stud y demonstrates that children with asthma can control their exacerbations at home using inhaled corticosteroids (budesonide). Treatment, starting with relatively high doses followed by a rapid reduction in dose over 4-8 days, resulted ill a decrease in the use of oral steroids and in hospitalization. To achieve good results, patient compliance is essential.