Abstract

ABSTRACT:
BACKGROUND:
Inhaled corticosteroids administered in high and repeated doses which effect simultaneously with bronchodilators is a way to maintain the effect throughout the time. The acute effects of nebulized budesonide as an emergency treatment of acute asthma in children have been evaluated in few clinical studies.
OBJECTIVE:
The analysis of the early clinical impact of adding repeated doses of nebulized budesonide in the treatment of acute asthma in the emergency setting on clinical respiratory score, Peak expiratory flow rates and hospital admission after 4 hours of treatment.
PATIENTS AND METHODS:
The study was a double-blind and placebo-controlled trial from April 2017 to January 2018 in children who attended the pediatric emergency unit at Children welfare teaching hospital due to an acute attack of asthma were evaluated. Clinical respiratory score and the peak expiratory flow rates were recorded in all patients at the start of the study by a pediatrician. Both groups received three consecutive doses of nebulized salbutamol (0.15 mg/kg/dose) and one dose of intravenous dexamethasone (0.15 mg/kg). During this treatment, for patients in group A the salbutamol nebulizer was mixed with normal saline while patients in group B three doses of nebulized budesonide (1mg/dose) which were combined with the nebulized salbutamol. Four hours later clinical respiratory scores and the peak expiratory flow rates were measured once more by the same blinded pediatrician.
RESULTS:
Respiratory rate showed significant difference between budesonide and placebo groups after 4 hours from the start of nebulizer therapy (P = 0.01). While others clinical respiratory scores variables like auscultation, accessory muscle, SPO2, color showed evident improvement after 4 hours but the differences were not statistically significant for each. The mean PEFR percent in budesonide group after 4 hours was (156±78.1) and that of placebo group was (119±37.9). Although the differences in PEFR between two groups was evident, it did not reach statistical significance (P= 0.3).
CONCLUSION:
The effectiveness of nebulized budesonide in addition to systemic steroids and nebulized salbutamol in early treatment of moderate asthmatic attacks in children 2-15 years of age in emergency setting clinically provided meaningful benefits in improving the clinical respiratory scores and PEFR and decreasing admission to the ward.