Efficacy of Inhaled Steroids (Beclomethasone Dipropionate) for Treatment of Mild to Moderately Severe Asthma in the Emergency Department: A Randomized Clinical Trial☆,☆☆,★,★★
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INTRODUCTION
In acute severe asthma exacerbations, systemic steroids are considered an essential component of treatment.1 Corticosteroids have been shown to be effective in speeding recovery and reducing the number of hospitalizations.2 The most common methods of steroid administration in the emergency department are the intravenous and oral routes.
Inhaled steroids, routinely used to treat chronic refractory asthma, have demonstrated an oral steroid–sparing effect, permitting some patients to reduce or even
METHODS AND MATERIALS
Patients who presented to the ED of the Sir Mortimer B. Davis–Jewish General Hospital with acute asthma5 and who met the following inclusion criteria were enrolled in the study: (1) 18 years of age or older, (2) able to perform spirometry, (3) FEV1 %pred 40% to 69%, and (4) written informed consent. Patients were excluded if any of these criteria were met: (1) patient in extremis, (2) long-term systemic steroid therapy (>1 month) within the last 6 months, (3) use of high-dose inhaled steroids
RESULTS
As shown in the trial profile (Figure 1), 54 patients were enrolled in the study; 28 were randomly assigned to the BDP group and 26 to the placebo group. Included in the intention-to-treat analyses were 3 patients who discharged themselves early (BDP=1, placebo=2), and 2 patients (BDP=1, placebo=1) who were withdrawn from the protocol because of worsening respiratory status. There was never an occasion to break any code during the trial. No other asthma medications were given
DISCUSSION
Asthma is primarily an inflammatory disease on which bronchospasm is superimposed.9 Guidelines emphasize that therapy must be geared toward managing both the bronchoconstriction, as well as the inflammatory component of the disease.1 As a result, this has led to recommendations for the early use of steroids in acute asthma.1 Inhaled steroids are increasingly used in the outpatient management of asthma, and are preferred over the systemic route because of their better therapeutic index. In
Acknowledgements
The authors acknowledge the diligent work and support of the emergency physicians and nurses in the realization of this project.
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Cited by (32)
Inhaled Corticosteroids in Acute Asthma: A Systemic Review and Meta-Analysis
2020, Journal of Allergy and Clinical Immunology: In PracticePediatric Asthma
2008, Primary Care - Clinics in Office PracticeInhaled budesonide in the management of acute worsenings and exacerbations of asthma: A review of the evidence
2007, Respiratory MedicineCitation Excerpt :Budesonide has a mean absorption time of 0.8 h compared with, for example, the 5.9 h required by fluticasone.53–56 There is evidence to suggest that lipophilic inhaled steroids may be less than optimal for the treatment of acute airway obstruction.33,57,58 Although there are no published head-to-head comparisons between budesonide and fluticasone in acute asthma, these two drugs have been used in our clinic.
Rapid effects of inhaled corticosteroids in acute asthma: An evidence-based evaluation
2006, ChestCitation Excerpt :Data for 1,133 subjects (470 adults and 663 children) were available for analysis. There were three types of protocols (Table 2): (1) ICS compared with placebo (eight studies29,3235,3639,4042,45); (2) ICS plus SCS compared with SCS (three studies31,33,43); and (3) ICS compared with SCS (six studies30,3437,3841,44). The ICS used were beclomethasone (three studies), dexamethasone (one study), flunisolide (two studies), budesonide (eight studies), and fluticasone (three studies).
Inhaled corticosteroids in the treatment of asthma exacerbations: Essential concepts
2006, Archivos de BronconeumologiaAsthma evaluation and management
2003, Emergency Medicine Clinics of North America
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Supported by a grant from Glaxo Canada and the Brownstein Endowment Fund. Dr Kreisman has participated in symposia and postgraduate courses funded by Glaxo Canada.
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Address for reprints: Marc Afilalo, MD, MCFP(EM), FRCP(C), Director Emergency Department, Sir Mortimer B. Davis–Jewish General Hospital, 3755 Chemin Côte Ste. Catherine, Room D-012, Montréal, Québec, H3T 1E2, Canada.
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