Nebulized budesonide in the patients with acute asthma exacerbation: A randomized clinical trial

Background: The management of asthma currently focuses on the Global Initiative for Asthma (GINA) guideline. This randomized clinical trial aimed to find whether the addition of nebulized budesonide to basic treatment would further improve the peak expiratory flow (PEF) rates and decrease the hospitalization days in patients through asthma exacerbation. Methods: Eligible patients with a definitive diagnosis of asthma exacerbation in the emergency department of Masih Daneshvari hospital were entered into this study. Patients were divided into the intervention and the control groups based on random numbers. To follow the GINA guidelines, both the groups received hydrocortisone (3 mg/kg slow IV stat) at the arrival, oxygen and nebulizer containing salbutamol and ipratropium bromide three times every 30 min and then every 8 h during the first 24 h. Nebulized budesonide (0.5 mg/2 ml) was added to the regimen of the intervention group and nebulized saline as the placebo in the control group. PEF of all eligible cases was measured on arrival and then at 1, 6, and 24 h after the ending of the first session of inhalation. Results: Hospitalization days decreased significantly in the intervention group (P <= 0.001). There was no median +/- standard deviation of PEF in the intervention group after 1 h (P = 0.019) and stayed higher than the control group on 6 and 24 h, respectively (P = 0.015 and P = 0.050). Conclusion: Adding nebulized budesonide to the main treatment regimen of an acute asthma attack helps the patients gaining better respiratory flow and reduces the hospitalization time.