SELECTED ARTICLES FROM THE RECENT LITERATURE 2005 11/30/05 Nebulized budesonide treatment in acute asthma exacerbations Summary Background - The role of inhaled corticosteroids (ICS) treatment in acute asthma exacerbations (AAE) is still debated. Findings - Sekerel et al of Hocettepe Univ in Ankara, Turkey carried out a randomized, double blind parallel group comparison of 5 days courses of nebulized budesonide (BUD), 1000 mcg per dose, vs placebo in 67 children with mild to moderate AAE. Each medication was given 3 times in the Emergency Dept, then b.i.d. during the next 4 days at home. They found similar degrees of initial improvement with the BUD and placebo treatments although systemic corticosteroid treatment was needed less often in the BUD treated children (2 out of 33 vs 7 out of 34; p=0.07). The authors concluded that there was a modest benefit of nebulized BUD in preventing progression of AAE episodes. Such benefit should be considered in light of cost and safety factors. Reference Acta Paediatr 2005;94:1372-7 Editor's Comments These findings of a quite modest beneficial effect of nebulized BUD in AAE are not too surprising to me. The respiration of children with AAE is often very "tight", perhaps limiting how much of the nebulized BUD reaches the lower airways. Perhaps timing the BUD nebulization soon after inhalation of albuterol may have led to a more pronounced benefit of this ICS. In the meantime, systemic corticosteroid therapy appears to be the preferential approach.   © Copyright 1997-2005 American Academy of Allergy, Asthma and Immunology All rights reserved