budesonide inhalation suspension for acute asthma in children

Conditions: Asthma; Acute Asthma; Reactive Airway Exacerbation

Summary: the purpose of this study is to determine whether the addition of budesonide inhalation suspension (bis) to the standard therapy of albuterol, ipratropium bromide, and systemic corticosteroids (scs) for moderate to severe asthma flares in children reduces asthma severity more rapidly than standard therapy alone.

context: acute asthma is a leading cause of emergency department (ed) visits and hospitalizations. although standard therapy for acute asthma includes systemic corticosteroids (scs), these drugs take many hours to have an effect. recent studies demonstrate that inhaled corticosteroids (ics) may improve patients' asthma severity more rapidly than scs and may decrease hospitalizations. only a few small studies have evaluated ics added to standard therapy for acute asthma in children. objective: to determine if adding the nebulized steroid budesonide to standard therapy including scs improves patients' asthma severity faster than standard therapy alone and leads to fewer hospitalizations. study design/setting/participants: a double-blind, randomized, controlled trial of budesonide inhalation suspension (bis) versus placebo for children 2 to 18 years of age who present to a tertiary care, urban pediatric ed with a moderate to severe asthma flare. intervention: participants will receive standard therapy including scs, albuterol, and ipratropium bromide and will be randomly assigned to also receive either nebulized bis or saline. study measures: differences in asthma scores, vital signs, and the need for hospitalization will be compared between treatment groups.

Eligibility criteria:
inclusion criteria: * chief complaint of "respiratory distress", "asthma", "trouble breathing", or "reactive airway disease" * males or females age 2 to 18 years * weight greater than or equal to 10 kilograms * two or more prior emergency department or primary care visits for asthma or reactive airway disease * identified in triage as either "acute" or "critical" * asthma score of 8 or greater * systemic corticosteroid prescribed in the emergency department * english-speaking parent/guardian present * parental/guardian permission (informed consent) and if appropriate, child assent exclusion criteria: * systemic corticosteroid use in the last 30 days * chronic lung diseases including cystic fibrosis * sickle cell anemia * immunodeficiency * cardiac disease requiring surgery or medications * adverse drug reaction or allergy to budesonide, albuterol, ipratropium bromide, prednisone, prednisolone, or methylprednisolone * known renal or hepatic dysfunction * exposure to varicella in the last 21 days * impending respiratory failure requiring positive pressure ventilation * altered level of consciousness * suspected foreign body aspiration or croup * prior enrollment in the study

Keywords: asthma acute treatment children pediatric inhaled corticosteroid budesonide budesonide inhalation suspension asthma score emergency emergency department asthma flare clinical trial randomized clinical trial randomized trial pulmonary index score hospitalization moderate asthma severe asthma mixing budesonide budesonide admixture albuterol continuous albuterol ipratropium bromide