Inhaled budesonide is typically used as a controller for persistent asthma, I disagreed with a fellow allergist who insisted that it has given good results when used to treat acute asthma. The medication insert does not indicate its use for acute exacerbations. What are your personal experiences?
Acute asthma can occur in two situations 1) acute exacerbations of chronic asthma , which is reversible by salbutamol nebulisation 2) acute severe asthma which would respond inadequately to salbutamol nebulisation & would need Intravenous/oral steroids for recovery .
Recent reports in acute severe asthma in children suggest that high dose budesonide nebulisation is as effective as intravenous/oral steroids & patients can be discharged in 2 hours after 3 nebulisations . It has been found effective in acute exacerbations of COPD .Steroids by their anti inflammatory effects are definitely beneficial in acute asthma .
I would recommend steroids if there is no response to salbutamol nebulisations for acute asthma .
Edmonds ML, Milan SJ, Camargo Jr CA, Pollack CV, Rowe BH. Early use of inhaled corticosteroids in the emergency department treatment of acute asthma. Cochrane Database of Systematic Reviews 2012, Issue 12. Art. No.: CD002308. DOI: 10.1002/14651858.CD002308.pub2
"Authors' conclusions: ICS therapy reduces hospital admissions in patients with acute asthma who are not treated with oral or intravenous corticosteroids. They may also reduce admissions when they are used in addition to systemic corticosteroids; however, the most recent evidence is conflicting. There is insufficient evidence that ICS therapy results in clinically important changes in pulmonary function or clinical scores when used in acute asthma in addition to systemic corticosteroids. Also, there is insufficient evidence that ICS therapy can be used in place of systemic corticosteroid therapy when treating acute asthma. Further research is needed to clarify the most appropriate drug dosage and delivery device, and to define which patients are most likely to benefit from ICS therapy. Use of similar measures and reporting methods of lung function, and a common, validated, clinical score would be helpful in future versions of this meta-analysis".
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