Effectiveness and Safety of Oral Triamcinolone in the Management of Acute Exacerbations of Asthma: A Prospective Interventional Study

Abstract

Introduction: Acute exacerbation of asthma leads to increased morbidity, mortality, and healthcare costs. Oral Corticosteroids (OCS) are critical in the management of asthma exacerbations; however, the response varies between patients. While there are some studies about a good response to Intramuscular (IM) triamcinolone, there is no data about the effect of oral triamcinolone on objective parameters during asthma exacerbations. Aim: To evaluate the effectiveness and safety of oral triamcinolone as an adjunct to Standard-Of-Care (SOC) comprising Inhaled Corticosteroids (ICS) with or without Long-Acting β2-Agonist (LABA) in treating mild-to-moderate exacerbations of asthma. Materials and Methods: This was a prospective, interventional, single-arm, single-centre, open-label study. Adults with bronchial asthma on stable doses of asthma medications for at least three months and presenting with mild-to-moderate exacerbation were recruited. Oral triamcinolone 4-16 mg/day for seven days was prescribed depending on exacerbation severity. Improvements in the Asthma Control Questionnaire (ACQ-6) score, Forced Expiratory Volume in 1 second (FEV1), and Peak Expiratory Flow Rate (PEFR) were evaluated. All patients in the study who had taken at least one dose of the study medication were included in the Intention-To-Treat (ITT) set. All patients in the ITT set who completed the study as Per Protocol (PP) were included in the PP set and considered for effectiveness analysis. Qualitative data are presented as numbers (n) and percentages (%), and quantitative data as n, mean, and Standard Deviation (SD). Quantitative variables were further evaluated using paired t-test at a 5% level of significance. Results: A total of 100 (38 males and 62 females) patients with a mean±SD age of 45.2±12.7 years were enrolled. The mean ACQ score decreased from 2.2 to 1.4 (p-value<0.001), mean FEV1 increased from 1.6 to 1.7 L/s (p-value<0.001), and the mean±SD PEFR increased significantly from 251.5±90.0 to 270.4±88.3 L/ min (p-value<0.001) on day 7. Overall, triamcinolone was welltolerated with no serious Adverse Events (AE). Conclusion: In patients with mild-to-moderate asthma exacerbations, oral triamcinolone as an adjunct to SOC improved ACQ-6 score, FEV1, and PEFR with a favourable safety profile. These findings support the use of oral triamcinolone for treating acute exacerbations of asthma.