Background: Short courses of oral prednisolone are used as rescue therapy for severe asthma exacerbations. This study compares nebulised budesonide or oral prednisolone, both followed by budesonide Turbohaler®, as a treatment for severe asthma exacerbations, in the absence of life-threatening features. Patients and Methods: Thirteen adults admitted to hospital were randomised to receive either nebulised budesonide (4mg 8-hourly) for 48 to 72 hours followed by budesonide Turbohaler® (1600μg twice daily for 7 days, then 800μg twice daily for 21 days) for 28 days or prednisolone (40mg daily) for 9 to 11 days followed by budesonide Turbohaler® (800μg twice daily) for 21 days. The primary efficacy variable was the change from baseline at 48 hours in forced expiratory volume in 1 second (FEV1). Secondary efficacy variables included an assessment of symptom severity (0 = none, 1 = mild, 2 = moderate, 3 = severe). Results: Difficulties were experienced with patient recruitment in the emergency setting. The results presented are from an incomplete study. Change in FEV1 from baseline to 48 hours was not statistically significantly different between the groups (the study was underpowered to detect a difference in change in FEV1, as the power to detect a prespecified difference between groups was 18%). Nebulised budesonide significantly reduced the severity of wheeze after 24 hours compared with prednisolone [estimate of treatment effect = −0.95; 95% confidence intervals (CI) = −1.76 to −0.15; p = 0.0336 between groups] and 48 hours (estimate of treatment effect = −0.79; 95% CI = −1.42 to −0.15; p = 0.0326 between groups). Conclusion: While oral prednisolone or intravenous hydrocortisone, oxygen and bronchodilators are the mainstay of acute management in severe asthma, the results of this study suggest that nebulised budesonide may assist in regaining control of symptoms during exacerbations of asthma.
背景:短期口服
泼尼松龙用于治疗严重哮喘急性发作。本研究比较了雾化
布地奈德或口服
泼尼松龙(两者均随后使用
布地奈德 Turbohaler®)作为治疗严重哮喘发作(在没有危及生命的特征的情况下)的情况。患者和方法:13 名入院成人随机接受雾化
布地奈德(4 毫克,每 8 小时)治疗 48 至 72 小时,然后接受
布地奈德 Turbohaler®(1600μg,每天两次,持续 7 天,然后 800μg,每天两次,持续 21 天)治疗 28 小时。或
泼尼松龙(每日 40 毫克)持续 9 至 11 天,然后使用
布地奈德 Turbohaler®(800 微克,每日两次)持续 21 天。主要疗效变量是 48 小时时 1 秒用力呼气量 (FEV1) 相对于基线的变化。次要功效变量包括症状严重程度的评估(0 = 无,1 = 轻度,2 = 中度,3 = 严重)。结果:在紧急情况下招募患者遇到了困难。所提供的结果来自一项不完整的研究。各组之间 FEV1 从基线到 48 小时的变化没有统计学上的显着差异(该研究不足以检测 FEV1 变化的差异,因为检测组间预设差异的功效为 18%)。与
泼尼松龙相比,雾化
布地奈德在 24 小时后显着降低了喘息的严重程度[治疗效果估计 = -0.95; 95% 置信区间 (CI) = −1.76 至 −0.15;组间 p = 0.0336] 和 48 小时(治疗效果估计值 = -0.79;95% CI = -1.42 至 -0.15;组间 p = 0.0326)。结论:虽然口服
泼尼松龙或静脉注射
氢化可的松、
氧气和支气管扩张剂是严重哮喘急性治疗的主要方法,但本研究的结果表明,雾化
布地奈德可能有助于在哮喘发作期间重新控制症状。