Efficacy of nebulized therapy of bronchial asthma exacerbation with budesonide suspension

Abstract

The aim of this trial was to evaluate efficacy of budesonide suspension for treatment of asthma exacerbations in comparison with systemic corticosteroids (SCS) with regards to clinical and functional changes and also to inflammatory activity in induced sputum (IS) and exhaled breath condensate (EBC). The trial involved 56 inpatients, mean age, 49.1 ± 14.3 years, with moderate and severe asthma exacerbation. The patients were divided into 2 groups: the 1st group (26 patients) received nebulized budesonide suspension ( Pulmicort Respules, AstraZeneca ) 2.0 mg b.i.d., the 2nd group (30 patients) were treated with oral prednisolone 30 mg daily with gradual reduction of the dose followed by withdrawal the drug. Moreover, all the patients received nebulized bronchodilators, oxygen supplementation if needed, expectorants, antibiotics, and medications for co-morbidities. Effectiveness of therapy for asthma exacerbation was evaluated with reduction in asthma attacks and additional use of short-acting β 2 -agonists, improvement in daily physical activity and peak expiratory flow rate (PEFR). Spirometry with assessment of bronchodilator response, IS cell count, and measurement of NO metabolites in EBC were performed before and after treatment. In all patients, the treatment resulted in significant improvement in clinical and functional parameters with no difference between the groups. Dyspnea and wheezing improved more in budesonide group than were in prednisolone group. Good asthma control was achieved in 18 patients of the budesonide group (75 %) and in 21 patients of the prednisolone group (70 %). Partial control of asthma was achieved in 6 (25 %) and 9 (30 %) patients, respectively. The mean duration of treatment was longer in prednisolone group (9.3 ± 1.1 vs. 6.1 ± 1.0 days respectively, р < 0.001). Cytosis, eosinophil and neutrohil counts reliably decreased and macrophages number increased, EBC NO metabolite levels significantly reduced in both the groups with no difference between the groups. IS cell counts and EBC NO metabolite levels correlated to the degree of asthma control. Generally, the therapy with nebulized buidesonide was welltolerated, adverse events were more frequent in prednisolone group. Therefore, nebulized budesonide suspension was as highly clinically effective in asthma exacerbation as SCS; it could be used as the alternative drug with better safety profile.