Efficacy of inhaled steroids (Beclomethasone dipropionate) for treatment of mild to moderately severe asthma in the emergency department: A randomized clinical trial

Study objective: To examine the efficacy of an inhaled steroid, when added to a standard regimen of P-agonist therapy, in the treatment of patients with mild to moderately severe asthma in the emergency department. Methods: A convenience sample of adult patients with asthma (FEV1 %predicted 40% to 69%) presenting to the ED was randomly assigned in a double-blind fashion into 2 treatment groups. The first group received 2.5 mg nebulized salbutamol plus 1 mg (4 puffs) of beclomethasone dipropionate (BDP) at baseline, 30 minutes, and at 1, 2, and 4 hours, delivered by a metered-dose inhaler (NIDI) attached to a spacer device (Vent-AH-aler, Glaxo). The second group was given the same salbutamol regimen plus MDI placebo through the Vent-AH-aler. The primary endpoint was improvement in FEV1 %predicted at 6 hours. Results: Of 54 patients enrolled, 28 were assigned to the BDP group and 26 to the placebo group. Spirometry improved significantly in both groups over the 6 hours compared with baseline (ANOVA, P < .001). At 6 hours, the mean absolute improvement in FEV, %predicted for BDP was 18% versus 17% for placebo (95% confidence interval for the absolute difference of 1% [-8% to 10%]). The proportion of patients in the BDP group who were hospitalized was 7% compared with 19% for patients in the placebo group (95% confidence interval for the difference of 22% [-6%, 30%]). Conclusion: In this group of patients with mild to moderately severe asthma, 5 mg BDP delivered by MDI during the initial 4 hours of an emergency visit was df no added benefit over standard therapy, as measured by improvement in FEV, %predicted at 6 hours. However, a trend toward a difference in admission favoring BDP was observed.