Comparison of single 2,000-[mu]g dose treatment vs sequential repeated-dose 500-[mu]g treatments with nebulized budesonide in acute asthma exacerbations

Background: High repeated doses of inhaled corticosteroids (ICSs) are recognized as having a more rapid improvement of outcomes than a single dose of ICS in severe acute asthma. However, to our knowledge, there has been no direct comparison of the early effects of single or repeated administration of the same total dosage of ICS in children with moderate to severe exacerbations of asthma. Objective: To compare the efficacy of a single dose of 2,000 [mu]g of nebulized budesonide with 4 repeated doses of 500 [mu]g of nebulized budesonide in 40 children with an acute asthma exacerbation. Methods: Randomized, double-blind, parallel study that compared the efficacy of 2,000 [mu]g of nebulized budesonide, administered in a single dose, with repeated doses (4 doses of 500 [mu]g each) during the first 90 minutes in 40 children (mean [SD] age, 10.7 [2.4] years) with an acute asthma exacerbation that required treatment with an oral corticosteroid. Forced expiratory volume in 1 second, asthma attack score, and oxygen saturation were evaluated at 20, 40, 60, 90, 120, 180, and 240 minutes after initial treatment. Oral corticosteroids were given to all patients at 90 minutes. Results: There were no significant differences in forced expiratory volume in 1 second (P = .54) at any times between the groups. Also, asthma scores and oxygen saturation were not different in either group within 90 minutes (P = .51 and P = .64, respectively) and thereafter (P = .35 and P = .87, respectively). Conclusion: The use of a single dose of nebulized budesonide is as effective as repeated administration of the same total dosage during the first 90 minutes before giving oral corticosteroids in children with moderate to severe exacerbations of asthma.