SELECTED ARTICLES FROM THE RECENT LITERATURE 2005
9/14/05
Nebulized fluticasone vs budesonide in acute asthma exacerbations
Summary
Background - Inhaled corticosteroids (ICS) are frequently administered by nebulization in the treatment of acute asthma exacerbations (AAE) in children. Are particular ICS agents particularly effective in such settings?
Findings - DeBenedictus et al of the Univ of Perugia and other institutions carried out a randomized, single blind parallel group comparison of nebulized fluticasone propionate (FP) 250 mcg b.i.d. vs nebulized budesonide (BUD), 500 mcg b.i.d. for 10 days in 168 children, ages 4-15 years with mild AAE. After 7 days of treatment, they found that morning PEFR was improved significantly more in those treated with FP (p=0.03). However, the percentage of symptom free nights was significantly higher in patients treated with BUD (p=0.006). The other symptom parameters and pulmonary function tests were not significantly different in the FP vs BUD treated patients. There was no suppression of the HPA axis when this was evaluated.
Reference
J Asthma 2005;42:331-6
Editor's Comments
My impression of the findings in this study is that there was no major difference in the efficacy of nebulized FP and nebulized BUD in mild AAE in children. The authors stressed that the equivalent clinical benefit was seen with half the daily dose of FP (500 mcg) than of BUD (1000 mcg). It is well recognized that FP is often more effective than other ICS given in the same doses because of the higher binding affinity of FP to corticosteroid receptors in the airways. However, when ICS are absorbed from the lung into the systemic circulation, FP would bind more avidly to corticosteroid receptors on other organ tissues resulting in a greater potential for adverse systemic effects. These effects are not so evident during the relatively short (10 day) duration of ICS treatment in this study - hence the absence of any suppression of HPA axis activity.
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