Nebulized budesonide combined with systemic corticosteroid vs systemic corticosteroid alone in acute severe asthma managed in the emergency department: a randomized controlled trial

Soudani Marghli, Chafiaa Bouhamed, Amira Sghaier, Nabil Chebbi, Insaf Dlala, Samia Bettout, Achref Belkacem, Sarra Kbaier, Nahla Jerbi, Abdelouahab Bellou, Soudani Marghli, Chafiaa Bouhamed, Amira Sghaier, Nabil Chebbi, Insaf Dlala, Samia Bettout, Achref Belkacem, Sarra Kbaier, Nahla Jerbi, Abdelouahab Bellou

Abstract

Background: The additive benefit of inhaled corticosteroid when used with systemic corticosteroid in acute asthma is still unclear. The objective of this study was to assess the effect of high and repeated doses of inhaled budesonide when combined with the standard treatment of adult acute asthma.

Methods: It was a prospective double-blind randomized controlled study performed in the emergency department (ED) from May 1, 2010 to February 28, 2011 (ClinicalTrials.gov, NCT04016220). Fifty patients were included and were randomized to receive intravenous hydrocortisone hemisuccinate in association with nebulized budesonide (n = 23, budesonide group) or normal saline (n = 27, control group). Nebulization of budesonide or saline was done in combination with 5 mg of terbutaline every 20 min the first hour, then at 2 h (H2), and 3 h (H3). All patients received standard treatment. Efficacy and safety of inhaled budesonide were evaluated every 30 min for 180 min.

Results: A significant increase in peak expiratory flow (PEF) was observed in both treatment groups at evaluation times. The increase in PEF persisted significantly compared to the previous measurement in both groups. There was no significant difference in the PEF between the two groups at evaluation times. There was no significant difference between the two groups in the evolution in the respiratory rate and heart rate. There was also no statistically significant difference between the two groups in the rate of hospitalization, the discharge criteria before the end of the protocol.

Conclusions: Considering its limited power, our study suggests that the association of nebulized budesonide with hydrocortisone hemisuccinate has no additional effect over the use of hydrocortisone alone in adults' acute asthma managed in the ED.

Keywords: Acute asthma; Emergency department; Nebulized budesonide; Systemic steroid.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Study protocol. GrBD: budesonide group, GrC: control group, HCHS: hydrocortisone hemisuccinate, i.v.: intravenously
Fig. 2
Fig. 2
Trial Flowchar
Fig. 3
Fig. 3
Evolution of PEF. *Values in both groups were significantly better than previous evaluation. ** p < 0.05 vs T150 in control group. PEF: peak expiratory flow

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