Effectiveness of Inhaled Corticosteroids in Controlling Acute Asthma Exacerbations in Children at Home

Many clinicians advise their patients to increase the dose of inhaled corticosteroids during acute asthma exacerbations, without strong clinical evidence supporting this treatment. This study investigates the effectiveness of inhaled corticosteroids in controlling acute asthma exacerbations in children at home. The study population consisted of children with mild intermittent, mild and moderate persistent asthma aged 1 to 14 years who were treated in our outpatient clinic with inhaled budesonide for 1 year. After participating in an asthma education session, the parents were instructed to initiate treatment with inhaled budesonide at the first signs of asthma exacerbation, starting with 200 to 400 pg budesonide, in combination with beta-2 agonists 4 times a day and followed by a decrease in the dose in 4 to 8 days. Asthma status and peak expiratory flow rates were measured in the 3 monthly follow-up visits. Only children who complied with the treatment regimen and came for follow-up visits regularly were included in the final analysis. One hundred fifty children used our treatment protocol with inhaled budesonide to control their asthma attacks. Clinical improvement of asthma symptoms was achieved after a mean of 1.8 +0.7 days from the beginning of treatment. The parents were able to control 94% of the 1,061 episodes of asthma exacerbation occurring during a cumulative follow-up period of 239 years. In the 3-month period before enrollment, 101 children (67%) had used oral corticosteroids to control their asthma attacks and 50 (33%) were hospitalized. During the entire follow-up period, only 11 children (7%) used oral corticosteroids, and none of the children were hospitalized. The present study demonstrates that children with asthma can control their exacerbations at home using inhaled corticosteroids (budesonide). Treatment, starting with relatively high doses followed by a rapid reduction in dose over 4-8 days, resulted in a decrease in the use of oral steroids and in hospitalization. To achieve good results, patient compliance is essential.

[1]  S. Shalitin,et al.  Effectiveness and safety of inhaled corticosteroids in controlling acute asthma attacks in children who were treated in the emergency department: a controlled comparative study with oral prednisolone. , 1998, The Journal of allergy and clinical immunology.

[2]  S. Williams,et al.  Treatment of acute asthmatic exacerbations with an increased dose of inhaled steroid , 1998, Archives of disease in childhood.

[3]  H. Blau,et al.  Rapid induction of clinical response with a short-term high-dose starting schedule of budesonide nebulizing suspension in young children with recurrent wheezing episodes. , 1998, The Journal of allergy and clinical immunology.

[4]  S. Holgate,et al.  Effect of inhaled corticosteroids on episodes of wheezing associated with viral infection in school age children: randomised double blind placebo controlled trial , 1997, BMJ.

[5]  S. Williams,et al.  Application of asthma action plans to childhood asthma: a national survey. , 1997, The New Zealand medical journal.

[6]  N. Kuppermann,et al.  Intravenous versus oral corticosteroids in the management of acute asthma in children. , 1997, Annals of emergency medicine.

[7]  M. Levy,et al.  Comparison of short courses of oral prednisolone and fluticasone propionate in the treatment of adults with acute exacerbations of asthma in primary care. , 1996, Thorax.

[8]  C. Delacourt,et al.  Efficacy of nebulized budesonide in treatment of severe infantile asthma: a double-blind study. , 1996, The Journal of allergy and clinical immunology.

[9]  A. Tal,et al.  Deposition pattern of radiolabeled salbutamol inhaled from a metered-dose inhaler by means of a spacer with mask in young children with airway obstruction. , 1996, The Journal of pediatrics.

[10]  G. Wennergren,et al.  Nebulized budesonide for the treatment of moderate to severe asthma in infants and toddlers * , 1996, Acta paediatrica.

[11]  E. Nyberg,et al.  Intermittent treatment with inhaled steroids for deterioration of asthma due to upper respiratory tract infections , 1995, Acta paediatrica.

[12]  R. Sharma,et al.  Lung deposition of budesonide from Turbuhaler is twice that from a pressurized metered-dose inhaler (P-MDI) , 1995, The European respiratory journal.

[13]  B. Volovitz,et al.  Growth and pituitary-adrenal function in children with severe asthma treated with inhaled budesonide. , 1993, The New England journal of medicine.

[14]  S. Fuchs,et al.  Controlled trial of oral prednisone in the emergency department treatment of children with acute asthma. , 1993, Pediatrics.

[15]  W. Lenney,et al.  Prevention of viral induced asthma attacks using inhaled budesonide. , 1993, Archives of disease in childhood.

[16]  B. H. Rowe,et al.  Effectiveness of steroid therapy in acute exacerbations of asthma: a meta-analysis. , 1992, The American journal of emergency medicine.

[17]  A. Dirksen,et al.  Single‐dose inhaled budesonide in subjects with chronic asthma , 1991, Allergy.

[18]  Andrew B. Ziller.  Early administration of corticosteroids in emergency room treatment of acute asthma , 1991 .

[19]  M. Silverman,et al.  Treatment of acute, episodic asthma in preschool children using intermittent high dose inhaled steroids at home. , 1990, Archives of disease in childhood.

[20]  J. Baskerville,et al.  Bioequivalent doses of budesonide and prednisone in moderate and severe asthma. , 1989, The Journal of allergy and clinical immunology.

[21]  G. Morrow.  Residency training in management of child abuse. , 1988, Pediatrics.

[22]  R. Cohen,et al.  Intravenous methylprednisolone efficacy in status asthmaticus of childhood. , 1987, Pediatrics.

[23]  W. Lenney,et al.  EFFECT OF A SINGLE ORAL DOSE OF PREDNISOLONE IN ACUTE CHILDHOOD ASTHMA , 1987, The Lancet.

[24]  G. Milavetz,et al.  Early intervention with short courses of prednisone to prevent progression of asthma in ambulatory patients incompletely responsive to bronchodilators. , 1987, The Journal of pediatrics.

[25]  B. Littenberg,et al.  A controlled trial of methylprednisolone in the emergency treatment of acute asthma. , 1986, The New England journal of medicine.

[26]  S. Fiel,et al.  Compliance with an experimental drug regimen for treatment of asthma: its magnitude, importance, and correlates. , 1984, Journal of chronic diseases.

[27]  E. R. Mcfadden,et al.  A controlled study of the effects of single doses of hydrocortisone on the resolution of acute attacks of asthma. , 1976, The American journal of medicine.