[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, FEV(1) and FEV(1)% were significantly improved in both groups (P < 0.05). The CS in BUD group was significantly lower than that in control group at the end of 2 h after the third dose of nebulization 0 (0) vs 0 (1), Z = 2.522, P = 0.012. There were no significant differences in RR, HR and SaO2 between 2 groups (P > 0.05). The improvement of FEV(1)% 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 FEV(1) 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%, χ(2) = 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%, χ(2) = 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).


CONCLUSIONS
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.
The State Key Laboratory of Respiratory Disease, the First Affiliated Hospital of Guangzhou Medical College, Guangzhou 510120, China.
Ai-huan
AH
Chen
Rong-chang
RC
Chen
Jie-yi
JY
Zhan
Sui
S
Huang
Yu-neng
YN
Lin
De-hui
DH
Chen
Cui-zhen
CZ
Yang
Nan-shan
NS
Zhong
D000280:Administration, Inhalation; D000293:Adolescent; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D019819:Budesonide / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers; D016896:Treatment Outcome
D001993:Bronchodilator Agents; D019819:Budesonide