The efficacy of nebulized budesonide in acute moderate to severe exacerbations of asthma in children

Objective To evaluate the effect of nebulized budesonide(BUD) in acute moderate to severe exacerbations of asthma in children. Methods Forty children, 5 to 15 years of age, with acute moderate to severe attacks of asthma, were randomized into BUD group and control group, receiving nebulized 0.5% salbutamol(150 μg/kg)+ 0.025% ipratropium bromide(1 ml)+ 0.05% budesonide(2 ml) or nebulized 0.5% salbutamol(150 μg/kg)+ 0.025% ipratropium bromide(1 ml) + saline(2 ml) at half–hourly intervals for 3 doses respectively. Lung function, respiratory rate(RR), heart rate(HR), oxygen saturation(SaO2) and clinical score(CS) were monitored. Results The baseline characteristics of the 2 groups were similar. After 3 doses of nebulization, CS, RR, SaO2, FEV1 and FEV1% were significantly improved in both groups(P 0.05). The improvement of FEV1% in the first hour and the second hour after 3 doses of nebulization was 8.0(6.8)% and 5.5(6.5)% in BUD group, and 6.0(8.5)% and 1.0(6.5)% in control group, the improvement in BUD group being significantly greater than that in control group(Z=2.270 and 2.686, P=0.023 and 0.007 respectively). The improvement of FEV1 in the second hour after 3 doses of nebulization was significantly greater in BUD group than in control group 0.07(0.12)L vs 0.01(0.10)L, Z=2.455, P=0.014. The full recovery rate in BUD group at the end of 2 h after completion of nebulization was significantly higher than that in control group(17/20, 85.0% vs 9/18, 50.0%, χ2=5.371, P=0.024). The proportion of patients who needed to use oral corticosteroids was significantly lower in BUD group than in control group(3/20, 15.0% vs 8/18, 44.4%, χ2=3.993, P=0.046). The hospitalization rate was 5%(1/20) in BUD group, and 17%(3/18) in control group, but the difference was not statistically significant(P>0.05). Conclusion Nebulized BUD in high dose and at short intervals combined with rapid–acting bronchodilators has an additional bronchodilator response, associated with more rapid and better improvement in clinical symptoms and lung function, indicating that it is preferred in the early management of acute moderate to severe exacerbation of asthma in children. Key words: Child; Asthma; Glucocorticoids