title: Comparison of nebulized budesonide and oral prednisolone with placebo in the treatment of acute exacerbations of chronic obstructive pulmonary disease: a randomized controlled trial.
abstract: Nebulized budesonide has been used successfully to treat acute asthma exacerbation, and we hypothesized that it could also be effective for exacerbations of chronic obstructive pulmonary disease (COPD). In this multicenter, double-blind, randomized, placebo-controlled trial, the efficacy of nebulized budesonide (Pulmicort Respules/Nebuamp), oral prednisolone, and placebo was compared in 199 patients with acute exacerbations of COPD requiring hospitalization. Patients received from randomization (H(0)) to 72 h (H(72)), 2 mg of budesonide every 6 h (n = 71), 30 mg of oral prednisolone every 12 h (n = 62), or placebo (n = 66). All received standard treatment, including nebulized beta(2)-agonists, ipratropium bromide, oral antibiotics, and supplemental oxygen. The mean change (95% confidence interval) in postbronchodilator FEV(1) from H(0) to H(72) was greater with active treatments than with placebo: budesonide versus placebo, 0.10 L (0.02 to 0.18 L); prednisolone versus placebo, 0.16 L (0.08 to 0.24 L). The difference in FEV(1) between budesonide and prednisolone was not significant, -0.06 L (-0.14 to 0.02 L). The occurrence of serious adverse events was similar for all groups. Budesonide had less systemic activity than prednisolone as indicated by a higher incidence of hyperglycemia observed with prednisolone. Both budesonide and prednisolone improved airflow in COPD patients with acute exacerbations when compared with placebo. Nebulized budesonide may be an alternative to oral prednisolone in the treatment of nonacidotic exacerbations of COPD but further studies should be done to evaluate its long-term impact on clinical outcomes after an initial episode of COPD exacerbation.
authors.affiliation: Centre de Recherche, Hôpital Laval, Institut Universitaire de Cardiologie et de Pneumologie de l'Université Laval, 2275 Chemin Ste-Foy, Ste-Foy, Quebec G1V 4G5, Canada. medfma@hermes.ulaval.ca
authors.forename: François
authors.initials: F
authors.lastname: Maltais
authors.forename: Juliette
authors.initials: J
authors.lastname: Ostinelli
authors.forename: Jean
authors.initials: J
authors.lastname: Bourbeau
authors.forename: André Bernard
authors.initials: AB
authors.lastname: Tonnel
authors.forename: Nadine
authors.initials: N
authors.lastname: Jacquemet
authors.forename: Jennifer
authors.initials: J
authors.lastname: Haddon
authors.forename: Michel
authors.initials: M
authors.lastname: Rouleau
authors.forename: Mohamed
authors.initials: M
authors.lastname: Boukhana
authors.forename: Jean Benoît
authors.initials: JB
authors.lastname: Martinot
authors.forename: Pierre
authors.initials: P
authors.lastname: Duroux
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000368:Aged; D019819:Budesonide / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D011239:Prednisolone / Q000008:administration & dosage* / Q000009:adverse effects; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy*; D012123:Pulmonary Ventilation / Q000187:drug effects; D014797:Vital Capacity / Q000187:drug effects
chemical_list: D019819:Budesonide; D011239:Prednisolone