Source: Annual Congress 2008 - Treatment and outcome of childhood asthma: new perspectives
Disease area: Airway diseases, Paediatric lung diseases

Abstract

The use of inhaled corticosteroid in acute wheezing is controversial. Objective: To compare the effectiveness of budesonide and prednisone in children with acute wheezing. Methods: Prospective, randomized, double-blinded, placebo controlled study comparing nebulized budesonide (n=30) with prednisone (n=30) and placebo (n=15) in 1 to 36 month-old eutrophic children without previous corticotherapy, hospitalized for acute moderate to very severe wheezing, and not responding to fenoterol. Clinical score and pulse oximetry were evaluated at 20, 40, 60, and 90 minutes, 2, 4, 6, 12, and 24h, and then daily for one week, followed by outpatient re-evaluation on 10^th and 15^th days. Inter and intra group comparisons were by Mann Whitney (5%) and Wilcoxon (1%). Results: Budesonide showed better clinical score and saturation at 20 minutes, maintained to the end of treatment (P<0.005). Equivalence occurred between systemic and inhaled corticosteroids after six hours (P=0.07). Therapeutic failure risk was 13 times higher with prednisone (95% CI-1.8 to 93.2) (P=0.0004). Relapse up to 1 month from high: 7.0% budesonide, 17.6% prednisone (P=0.03). Conclusion: Budesonide showed earlier clinical and oxygenation improvement than prednisone in children with acute moderate to very severe wheezing not responding to fenoterol, guaranteeing low relapse.

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M. L. Silva, G. Fleischer Ferrari (Santo André / São Paulo, Botucatu/São Paulo, Brazil). Budesonide versus prednisone in acute wheezing: randomized double-blinded controlled placebo study. Eur Respir J 2008; 32: Suppl. 52, 4594

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