Chest
Clinical InvestigationsASTHMAA Randomized Controlled Trial of Inhaled Flunisolide in the Management of Acute Asthma in Children
Section snippets
Materials and Methods
A randomized, masked, placebo-controlled, parallel-group study was conducted in 55 children aged 6 to 16 years seeking care for an acute exacerbation of asthma. Patients were excluded from enrollment if they had underlying lung disease such as cystic fibrosis or bronchopulmonary dysplasia. Patients were also excluded if they required hospital admission or had an initial FEV1 <25% or > 80% of predicted.
Baseline spirometry, peak expiratory flow (PEF), heart rate, respiratory rate, pulse oximetry,
Results
A total of 58 subjects were enrolled, of whom 35 were male and 49 were African American. Baseline asthma severity, race, gender, and age were balanced between the two treatment groups (Table 1). Twelve patients (seven patients in the ICS group) were enrolled who were routinely receiving maintenance doses of ICS. Prior use of ICS did not alter the study results.
Contingency analysis showed no significant difference in symptom severity between the two groups at any time during the study.
Discussion
Earlier studies suggest that high-dose ICS are as effective as OCS in treating acute asthma in adults24,25 and children,26,27,28,29 although data regarding pediatric asthma were not as clear.30 In a study comparing budesonide, 1,600 μg/d, by Turbuhaler (Astra; Lund, Sweden), or oral prednisone, 2 mg/kg, therapy in children with acute asthma, there was an earlier response in those treated with budesonide as measured by pulmonary index scores and PEF. They also found serum cortisol levels were
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Cited by (32)
Asthma: Treatment of exacerbations
2012, Revue des Maladies RespiratoiresPediatric Asthma
2008, Primary Care - Clinics in Office PracticeCitation Excerpt :However, because of small numbers and possible limitation to mild asthma exacerbations, equivalency could not be claimed [41]. Finally, a pediatric study showed that, although inhaled corticosteroids were beneficial, patients experienced a more rapid resolution of symptoms with systemic corticosteroids if improvement of lung function was the outcome [42]. While initiating or doubling the dose of inhaled corticosteroids during acute mild asthma exacerbation has emerged to be a common practice among practitioners in an attempt to prevent the need for systemic corticosteroid therapy or development of more severe symptoms, there is no clear consensus of the exact role inhaled corticosteroids should have in the management of exacerbations in general [43].
Management of Acute Asthma
2008, Pediatric Emergency MedicineConsensus statement on the management of paediatric asthma. Update 2007
2008, Allergologia et ImmunopathologiaConsensus on the treatment of asthma in pediatrics
2007, Anales de PediatriaReview of Asthma: Pathophysiology and Current Treatment Options
2007, Clinical Pediatric Emergency MedicineCitation Excerpt :Although it is still unclear if ICS could replace SCS [57-59], ICS may also have a sparing effect on SCS [60]. Of the available inhaled formulas, budesonide in doses ranging from 200 to 2000 μg [52,57,58,61] and flunisolide (400 μg-18 mg) [62,63] have been shown to be beneficial. In our institution, we are currently using 1.5 mg budesonide inhalation solution with our CN.
Presented at the American Academy of Pediatrics 2000 Annual Meeting, Chicago, IL; October 27–31, 2000.
Funded by a grant from Forest Laboratories.
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