Budesonide Nebulization Added to Systemic Prednisolone in the Treatment of Acute Asthma in Children A Double-Blind, Randomized, Controlled Trial

Background: Inhaled corticosteroids, known to be effective as a maintenance medication in chronic asthma, have also been suggested as a therapy for acute asthma when given at high doses. Methods: A double-blind, randomized, placebo-controlled trial was conducted in children aged 2 to 12 years with moderate or severe acute asthma, as determined based on a clinical score of 5 to 15 points, where 15 is the most severe. We compared the addition of budesonide 1,500 m g vs placebo to standard acute asthma treatment, which included salbutamol, ipratropium bromide, and a single dose of prednisolone 2 mg/kg given at the beginning of therapy. The primary outcome was hospital admission rate within 4 h. Results: A total of 906 ED visits by children with moderate or severe acute asthma were evaluated. Seventy-five cases out of 458 (16.4%) in the budesonide group vs 82 of 448 (18.3%) in the placebo group were admitted (OR, 0.84; 95% CI, 0.58-1.23; P =.38). However, among cases with high baseline clinical score (>= 13), significantly fewer children were admitted in the budesonide group (27 of 76 [ 35.5%]) than in the placebo group (39 of 73 [ 53.4%]; OR, 0.42; 95% CI, 0.19-0.94; P -.03). Conclusions: The addition of budesonide nebulization did not decrease the admission rate of children with acute asthma overall. However, it may decrease the admission rate of children with severe acute asthma.