Acute Asthma Rx: Budesonide Does Not Add Benefit

Abstract

Research Article| December 01 2011 Acute Asthma Rx: Budesonide Does Not Add Benefit AAP Grand Rounds (2011) 26 (6): 62. https://doi.org/10.1542/gr.26-6-62 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Acute Asthma Rx: Budesonide Does Not Add Benefit. AAP Grand Rounds December 2011; 26 (6): 62. https://doi.org/10.1542/gr.26-6-62 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: asthma, acute, budesonide, prescriptions, drug, asthma Source: Upham BD, Mollen CJ, Scarfone RJ, et al. Nebulized budesonide added to standard pediatric emergency department treatment of acute asthma: a randomized, double-blind trial. Acad Emerg Med. 2011; 18(7): 665– 73; doi: https://doi.org/10.1111/j.1553- 2712.2011.01114.xGoogle Scholar To evaluate the utility of nebulized budesonide added to standard acute asthma therapy with systemic corticosteroids (SCS), albuterol, and ipratropium bromide, investigators from the emergency department (ED) at the Children’s Hospital of Philadelphia performed a randomized double- blind trial. Between November 2006 and October 2007, children aged 2 to 18 years with a history of asthma presenting to the ED with an acute asthma exacerbation were included if their asthma score (based upon clinical wheeze, retractions, respiratory rate, dyspnea, and oxygen saturation1 ) was 8 or higher and if SCS were prescribed. Patients who met eligibility criteria were randomized in strata by age and history of inhaled corticosteroid use to receive either 2 mg of nebulized budesonide or saline placebo. Via a shielded high-flow nebulization chamber, participating children received a total of three albuterol and two ipratropium treatments. Study drug or placebo was mixed with the second and third albuterol treatments. Study physicians evaluated patients hourly, recording additional asthma scores and determining whether to observe the patient for an hour, treat further with albuterol therapy, or discharge home. Children deemed stable for discharge after a minimum of two hours of improvement following the intervention received a four-day course of SCS. Guardians were contacted by telephone within three to five days after the ED visit. The primary outcome was the difference between study groups in median asthma score at two hours after intervention. Differences between groups with regard to hospitalization rate, respiratory rate, and oxygen saturation served as secondary outcomes. A total of 180 children were enrolled in the study. Eighty-eight patients received placebo and 91 received budesonide. About half of the children in each group were receiving inhaled corticosteroids prior to enrollment. Baseline characteristics were similar between study groups, except slightly more patients in the budesonide group had been hospitalized previously. The median improvement in asthma score at two hours was 3 in both the budesonide and placebo groups. Similarly, no significant differences in the change in respiratory rate or oxygen saturation were detected. Initial hospitalization rates were identical (62%) in both study groups. Four patients returned for hospitalization after ED discharge (2 in each study group) and one patient who received budesonide required transfer to the intensive care unit for a brief period with subsequent uneventful recovery. There were no other serious adverse events. The authors conclude that budesonide does not offer improved clinical benefit above standard ED therapy for children who experience a moderate to severe asthma exacerbation. Dr Stevenson has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. The National Asthma Education and Prevention Program’s Expert Panel Report-3 does not recommend increasing the... You do not currently have access to this content.