A comparison of nebulized budesonide with oral prednisolone in the treatment of exacerbations of obstructive pulmonary disease.
Nebulized corticosteroids in acute bronchospasm may offer topical anti-inflammatory activity while minimizing undesirable systemic effects. We compared the side-effect profile of nebulized budesonide (2 mg twice daily) with that of oral prednisolone (30 mg once daily) in a randomized parallel-group study of 19 adults with severe acute airway obstruction. Over the 5 days of the study, baseline forced expiratory volume in 1 second (FEV1) increased from 1.8 (95% confidence interval [CI], 0.7) to 2.1 (95% CI, 0.7) L in the group that received oral corticosteroids compared with 1.9 (95% CI, 0.7) to 2.0 (95% CI, 0.7) L in the group that received nebulized corticosteroid. All biochemical variables were similar at day 1. Comparison of budesonide treatment with prednisolone on day 5 showed that urinary corticosteroid metabolites were significantly higher (2012 [95% CI, 812] compared with 1079 [95% CI, 346] mg/24 hr [p < 0.05]), urinary androgen metabolites were not different, serum osteocalcin was elevated (2.3 [95% CI, 1.4] compared with 0.6 [95% CI, 0.6] ng/ml [p < 0.05]), and 24-hour urinary calcium to creatinine ratios were lower (0.28 [95% CI, 0.1] compared with 0.53 [95% CI, 0.2]), whereas urinary hydroxyproline to creatinine ratios were similar. The biochemical markers associated with corticosteroid side effects improve in patients treated with nebulized corticosteroids compared with patients who receive conventional treatment.
Morice
A H
AH
Department of Medicine and Pharmacology, Royal Hallamshire Hospital, Sheffield, England.
Morris
D
D
Lawson-Matthew
P
P
D000208:Acute Disease; D000284:Administration, Oral; D000287:Administration, Topical; D000328:Adult; D000336:Aerosols; D000728:Androgens / Q000652:urine; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D019819:Budesonide; D002118:Calcium / Q000652:urine; D003404:Creatinine / Q000652:urine; D005541:Forced Expiratory Volume / Q000187:drug effects; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006909:Hydroxyproline / Q000652:urine; D008173:Lung Diseases, Obstructive / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology / Q000652:urine; D015675:Osteocalcin / Q000097:blood; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D011282:Pregnenediones / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016896:Treatment Outcome
D000336:Aerosols; D000728:Androgens; D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D005938:Glucocorticoids; D011282:Pregnenediones; D015675:Osteocalcin; D019819:Budesonide; D011239:Prednisolone; D003404:Creatinine; D006909:Hydroxyproline; D002118:Calcium