title: Budesonide reduces hospital admission rates in preschool children with acute wheezing.
abstract: The object of this study was to determine whether high doses of inhaled budesonide provide additional benefits to a standardized treatment regimen that includes systemic steroids and salbutamol in preschool patients presented to the emergency department (ED) with acute wheezing attacks. Methods This randomized, double-blind, placebo-controlled, parallel group trial was conducted in children, 6 months-6 years with moderate or severe acute wheezing epizode, as determined based on a pulmonary index score (PIS) of 7-13 points. We compared the addition of budesonide 3 mg versus placebo to standard acute asthma treatment, which included salbutamol and a single 1 mg/kg dose of methylprednisolone given at the beginning of therapy. The primary outcome was differences in hospitalization rates within 4 hr. Secondary outcome was difference in median PIS between treatment groups at 2 hr. Results One hundred patients were enrolled. Cumulative hospitalization rate at 120, 180, and 240 min were 0.72, 0.62, and 0.58 in placebo group; and 0.44, 0.30, and 0.24 in budesonide group. Discharged rate in budesonide group was significantly higher than the placebo group (log-rank = 12.407 ve P < 0.001). Expected mean discharged times were 200.4 (95%CI = 185.3-215.5) min in placebo group and 164.4 (95%CI = 149.4-179.4) min in budesonide group. Median (25-75%) PIS at the 120th min was significantly lower in budesonide group than the placebo group (5 [4-8] vs. 8 [5-9] respectively, P = 0.006). Conclusions The addition of budesonide nebulization may decrease the admission rate of preschool children who have moderate to severe acute wheezing epizodes. Pediatr Pulmonol. 2017;52:720-728. © 2017 Wiley Periodicals, Inc.
authors.affiliation: Division of Pediatric Allergy, Acıbadem, Ankara Private Hospital, Ankara, Turkey.
authors.forename: Cem Hasan
authors.initials: CH
authors.lastname: Razi
authors.affiliation: Division of Pediatric Allergy, Department of Pediatrics, Sami Ulus Pediatrics and Gynecology Education and Research Hospital, Ankara, Turkey.
authors.forename: Nazlı
authors.initials: N
authors.lastname: Cörüt
authors.affiliation: Department of Pediatrics, Kecioren Education and Research Hospital, Ankara, Turkey.
authors.forename: Nesibe
authors.initials: N
authors.lastname: Andıran
mesh_terms: D000208:Acute Disease; D000420:Albuterol / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D019819:Budesonide / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009330:Nebulizers and Vaporizers; D012135:Respiratory Sounds / Q000187:drug effects*
chemical_list: D001993:Bronchodilator Agents; D019819:Budesonide; D000420:Albuterol; D008775:Methylprednisolone
keywords: acute asthma; budesonide; preschool children; recurrent wheezing