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Aerosolized Budesonide Therapy in Acute Moderate Exacerbations of Asthma

Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

PURPOSE: To assess the utility of inhaled corticosteroids for the early management of acute exacerbations of asthma in the emergency room.

METHODS: This randomized, double-blind, placebo-controlled study was conducted to evaluate the efficacy of high dose inhaled budesonide with frequent beta-2-agonist therapy in patients of acute moderate exacerbations of asthma. Seventy patients between 15 and 40 years of age with acute moderate exacerbations of asthma were put on aerosolized 800 µg of budesonide at half hourly intervals for three doses with metered dose inhaler and spacer. All patients received humidified oxygen and nebulized salbutamol (0.15 mg/kg in 3 ml saline) prior to budesonide administration. The control group received placebo instead of inhaled budesonide. Patients who had received corticosteroids in the preceding 72 h were excluded from the study. If there was an inadequate response or no response to treatment at the end of 2 hour, oxygen and salbutamol therapy were continued and given one dose of intravenous hydrocortisone and was started on an aminophylline infusion.

RESULTS: Both budesonide and control group showed a significant improvement in respiratory status at the end of 2 h. However, patients in the budesonide group showed greater improvement in PEFR ( p < 0.05) and significantly lower proportion of patients required oxygen improvement in PEFR ( p < 0.01). The length of stay was significantly shorter in the budesonide group than in the placebo group (p < 0.01).

CONCLUSION: Aerosolized budesonide therapy with MDI and spacer together with salbutamol in the treatment of acute exacerbations of asthma helped in early recovery and decreased hospital stay.

CLINICAL IMPLICATIONS: Inhaled budesonide may be given with MDI and spacer in the treatment of acute exacerbations of asthma.

DISCLOSURE: S.K. Agarwal, None.

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