Efficacy of nebulized budesonide suspension in acute severe asthma: a controlled trial

Abstract

A goal of the study was to evaluate efficacy of inhaled budesonide suspension via nebulizer compared with systemic steroids in acute severe bronchial asthma. We examined 68 patients admitted for acute severe asthma (FEV₁ < 40 %_pred., PEF < 150 L / min). A first step therapy included inhaled salbutamol 5 to10 mg, oxygen, prednisolone IV for 1.5 to 2 h. Then the patients were divided into 2 groups: good respondents (n = 32) with increase in FEV 1 up to 50 %_pred. at least and patients with insufficient response (n = 36) and co existing COPD which still had FEV₁ < 40 %_pred. The group 1 patients were randomized in 2 subgroups: experimental (budesonide 4 mg / day) and control (prednisolone 120 mg / day IV). All of the group 2 patients received oral prednisolone 30 mg / day and were also randomized in experimental (prednisolone + budesonide 4 mg / day) and control (prednisolone + placebo) subgroups. The clinical course and pulmonary function were assessed after 5 days of the treatment.
As a result, the efficacy of budesonide in the group 1 was similar to that of IV steroids. The group 2 patients receiving budesonide demonstrated faster clinical improvement and better FEV₁ and PEF dynamics as compared to the controls (p < 0.05). Administration of budesonide allowed reducing the duration of the steroid therapy.
So, inhaled budesonide can replace systemic steroids in patients with acute severe asthma and good response to the first step therapy. Early addition of budesonide to prednisolone in patients with more severe asthma and COPD allows to reach the asthma control faster and to reduce doses of steroids.