Nebulized Budesonide Added to Standard Pediatric Emergency Department Treatment of Acute Asthma: A Randomized, Double-blind Trial

Academic Emergency Medicine, 07/18/2011

Upham BD et al.– For children 2 to 18 years of age treated in the emergency department (ED) for acute asthma, a single 2–mg dose of budesonide added to standard therapy did not improve asthma severity scores or other short–term ED–based outcomes.

Methods

  • The authors conducted a randomized, double-blind, placebo-controlled trial in a tertiary care, urban pediatric ED.
  • Patients 2 to 18 years of age with moderate to severe acute asthma were randomized to receive either a single 2-mg dose of budesonide inhalation suspension (BUD) or normal sterile saline (NSS) placebo, added to albuterol, ipratropium bromide (IB), and systemic corticosteroids (SCS).
  • The primary outcome was the difference in median asthma scores between treatment groups at 2 hours.
  • Secondary outcomes included differences in vital signs and hospitalization rates.

Results

  • A total of 180 patients were enrolled.
  • Treatment groups had similar baseline demographics, asthma scores, and vital signs.
  • A total of 169 patients (88 BUD, 81 NSS) were assessed for the primary outcome.
  • No significant difference was found between groups in the change in median asthma score at 2 hours (BUD –3, NSS –3, p=0.64).
  • Vital signs at 2 hours were also similar between groups.
  • Fifty-six children (62%) were admitted to the hospital in the BUD group and 55 (62%) in the NSS group (difference 0%, 95% confidence interval [CI]=–14% to 14%).
  • Neither multivariate adjustment nor planned subgroup analysis by inhaled corticosteroids (ICS) use prior to the ED significantly altered the results.

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