SELECTED ARTICLES FROM THE RECENT LITERATURE 2006

12/4/06

Inhaled budesonide treatment of acute asthma exacerbations

Summary
Background - Treatment with inhaled corticosteroids (ICS) such as budesonide (Bud) is an integral part of the chronic management of persistent asthma. However, the value of ICS therapy in acute asthma exacerbations (AAE) is a subject of some debate.

Findings - Volovitz of the Schneider Children's Medical Center in Israel reviewed the literature for studies of the effects of inhaled Bud in the treatment of AAE. He concluded that a number of trials in both children and adults have shown clinical and spirometric beneficial effects of Bud delivered by nebulizers, dry powder inhalers and pressurized MDI. The beneficial effects of Bud appear to depend on repeated administration of high dosage Bud early in the course of an AAE. Despite the high dosage of Bud employed, there should be less potential for adverse systemic effects of this treatment when compared to the systemic corticosteroid therapy usually employed in the treatment of AAE.

Reference
Respir Med 2006;Nov 12, E pub

Editor's Comments
It is not surprising that high dosage ICS therapy can be beneficial in AAE provided that the patient can cooperate in the administration of this therapy and that the deep inhalation maneuver does not trigger prominent coughing episodes. However, a big question is whether such ICS therapy is as effective as systemic corticosteroid therapy in AAE. At least some studies indicate that systemic corticosteroid therapy is more effective.

 

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