title: High dose nebulized steroid in the treatment of chronic steroid-dependent asthma.
abstract: Despite the dramatic success of inhaled steroids in controlling asthma symptoms there remains a small number of patients in whom asthma can only be treated with continuous oral steroids. Eighteen such patients, aged 19-62 years (seven males, 11 females) were followed in an open trial of nebulized budesonide over 12-18 months. All had required at least 7.5 mg or more daily prednisolone to control their symptoms over the preceeding 2 or more years and were taking 1200 micrograms beclomethasone dipropionate or 1600 micrograms budesonide daily. With a daily dose ranging between 4 and 8 mg nebulized budesonide, 14 patients successfully stopped oral steroids while in three the dose was reduced; only one patient failed to benefit. There was an increase in the mean FEV1 from 1.9 (+/- 0.9) to 2.2 (+/- 0.9) l, and in the mean morning PEFR, from 238 (+/- 119) to 286 (+/- 130) l min-1. There was also a significant decrease in the mean number of hospital admissions for acute severe asthma, from 1.5 (+/- 1.8) to 0.9 (+/- 1.1) per year. These findings should encourage a careful and controlled evaluation of nebulized steroids as a substitute for oral steroids in this difficult group of asthmatics.
authors.affiliation: Department of Respiratory Physiology, Papworth Hospital, Cambridge, U.K.
authors.forename: B A
authors.initials: BA
authors.lastname: Otulana
authors.forename: N
authors.initials: N
authors.lastname: Varma
authors.forename: A
authors.initials: A
authors.lastname: Bullock
authors.forename: T
authors.initials: T
authors.lastname: Higenbottam
mesh_terms: D000328:Adult; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D019819:Budesonide; D002908:Chronic Disease; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D011239:Prednisolone / Q000627:therapeutic use; D011282:Pregnenediones / Q000008:administration & dosage / Q000627:therapeutic use*; D014797:Vital Capacity / Q000502:physiology
chemical_list: D011282:Pregnenediones; D019819:Budesonide; D011239:Prednisolone