To evaluate the efficacy of nebulized budesonide compared to oral prednisolone in the management of moderate exacerbation of acute asthma


  • Sushil Sharma Department of Pediatrics, Government Medical College, Jammu, Jammu and Kashmir, India
  • Rekha Harish Department of Pediatrics, Government Medical College, Jammu, Jammu and Kashmir, India
  • Neeti Dutt Department of Blood Transfusion Medicine, Government Medical College, Jammu, Jammu and Kashmir, India
  • Kishour Kumar Digra Department of Pediatrics, Government Medical College, Jammu, Jammu and Kashmir, India



Asthma, Budesonide, Exacerbation, Pulmonary score


Background: Corticosteroids are extremely effective drugs and are used extensively in the management of asthma. Inhaled corticosteroids may offer some benefit in patients with mild to moderate obstruction in acute exacerbation and also offer the advantage of administration directly to the lungs. Hence this study was done to evaluate the efficacy of nebulized budesonide as compared to oral prednisolone in the management of moderate exacerbation of acute asthma.

Methods: A total of 80 children attending pediatric emergency of SMGS Hospital Jammu aged 1 to 18 years with a moderate exacerbation of asthma despite three salbutamol nebulizations were enrolled and randomized into two groups. First group recieved nebulized budesonide (800 mcg) at hourly intervals for three doses followed by twice a day (n=37) while second group recieved oral prednisolone 2 mg/kg/day in two divided doses (n=43). Both groups continued to receive oxygen inhalation and nebulized salbutamol (0.15 mg/kg/dose) initially at hourly intervals for 3 doses followed by 6 hourly. The pattern of response as observed by the pulmonary scores in the two groups was compared.

Results: The pulmonary scores were significantly improved at 1, 2 and 6 hours after starting treatment in the budesonide group as compared to prednisolone group (p < 0.01) although the difference was not significant after 12 hours. Oxygen saturation also showed a significant early improvement.

Conclusions: This early demonstrable significant improvement in the clinical parameters of the inhaled budesonide group apparently suggests that inhaled budesonide may be efficacious in treating moderate exacerbations of asthma. 


Liu AH, Covar RA, Spahn JD, Leung DYM. Childhood Asthma. In: Kliegman, Behrman, Jenson, Stanton, eds. Nelson textbook of paediatrics 18th ed. International ed; 2007:chapter-143.

Expert panel report-3. Guidelines for diagnosis and management of Asthma-summary report 2007. J Allergy Clin Immunol. 2007;120:S94-138.

Schleimer RP. Glucorticoids,their mechanism of action in allergic diseases. In: Allergy:principles and practice. 5th ed.1998;6:638-60.

Scarfone RJ, Loiselle JM, Wiley JF 2nd, Decker JM, Henretig FM, Joffe MD. Nebulized dexamethasone versus oral prednisone in the emergency department of Asthmatic Children. Ann Emerg Med. 1995;26:480-6.

Bentley AM, Hamid Q, Robinson DS, Schotman E, Meng Q, Assoufi B, et al. Prednisolone treatment in Asthma. Reduction in the numbers of eosinophils, T cells, tryptase-only positive mast cells, and modulation of IL-4, IL-5, and interferon-gamma cytokine gene expression within the Bronchial mucosa Am. J. Respir. Crit. Care Med. 1996;153(2): 551-6.

Pedersen S, Steffensen G, Ekman I, Tonnesson M, Borga O. Pharmacokinetics of Budesonide in Children with Asthma. Eur J Clin Pharmacol. 1987;31:579-82.

Rowe BH, Spooner C, Ducharme F, Bretzlaff J, Bota G. Corticosteroids for preventing relapse following Acute Exacerbations of Asthma (Cochrane review). In: The Cochrane Library, Version 4. Oxford: Update Software; 2003.

Hendeles L, Sherman J. Are Inhaled Corticosteroids effective for Acute Exacerbations of Asthma in Children? J Pediatr. 2003;142:S26-33.

Rodrigo GJ. Rapid effects of inhaled corticosteroids in acute asthma: an evidence-based evaluation. Chest J. 2006;130:1301-11.

Kumar SD, Brieva JL, Danta I, Wanner A. Transient effect of inhaled fluticasone on airway mucosal blood flow in Subjects with and without Asthma. Am J Respir Crit Care Med. 2000;161:918-21.

Camargo CA Jr, Spooner CH, Rowe BH. Continuous versus intermittent beta-agonists in the treatment of acute Asthma. Cochrane Database Syst Rev. 2003b;(4):CD001115.

Karpel JP, Aidrich TK, Prejant DJ, Guguchev K, Gaitan-Salas A, Pathiparti R. Emergency treatment of acute Asthma with albuterol metered-dose inhaler plus holding chamber: how often should treatments be administered? Chest. 1997;112(2):348-56.

McFadden E Jr. Acute severe Asthma. Am J Respir Crit Care Med. 2003;168(7):740-59.

Edmonds ML, Camargo CA Jr, Pollack CV Jr, Rowe BH. Early use of Inhaled Corticosteroids in the emergency department treatment of acute Asthma. Cochrane Database Syst Rev 2003;(3):CD002308.

Rowe BH, Edmonds ML, Spooner CH, Diner B, Camargo CA Jr. Corticosteroid therapy for acute Asthma. Respir Med. 2004;98(4):275-84.

Harrison BD, Stokes TC, Hart GJ, Vaughan DA, Ali NA, Robinson AA. Need for intravenous hydrocortisone in addition to Oral Prednisolone in Patients admitted to hospital with severe Asthma without ventilatory failure. Lancet. 1986;1(8474):181-4.

Ratto D, Alfaro C, Sipsey J, Glovsky MM, Sharma OP. Are intravenous Corticosteroids required in status Asthmaticus? JAMA. 1988;260(4):527-9.

Devidayal, Singhi S, Kumar L, Jayshree M. Efficacy of Nebulized Budesonide compared to Oral Prednisolone in Acute Bronchial Asthma. Acta Paediatr. 1999;88:835-40.

Kelly L, Kolbe J, Mitzner W, Spannhake EW, Bromberger-Barnea B, Menkes H. Bronchial blood flow affects recovery from constriction in dog lung periphery. J Appl Physiol. 1986; 60:1954-9.

Mendes ES, Pereira A, Danta I, Duncan RC, Wanner A. Comparative Bronchial vasoconstrictive efficacy of inhaled Glucocorticosteroids. EurRespir J. 2003;21:989-93.

Sung L, Osmond NH, Klassen TP. Randomized, controlled trial of inhaled Budesonide as an adjunct o oral prednisone in acute Asthma. Acad Emerg Med. 1998;5:209-13.

Singhi S, Banerjee S, Nanjundaswamy H.Inhaled Budesonide in acute Asthma. J Paediatr Child Health. 1999;35(5):483-7.

Estrada-Reyes E, Del Rio-Navarro BE, Rosas Vargas MA, Nava Ocampo AA. Co-administration of Salbutamol and fluticasone for emergency treatment of Children with moderate acute Asthma. Pediatr Allergy Immunol. 2005;16:609-14.

Sekerel BE, Sackesen C, Tuncer A, Adalioglu G. The effect of Nebulized Budesonide treatment in Children with mild tomoderate Exacerbations of Asthma. Acta Paediatr. 2005;94:1372-7.

Volovitz B, Bentur L, Finkelstein Y,Mansour Y, Shalitin S, Nusssinovitch M, et al. Effectiveness and safety of Inhaled Corticosteroids in controlling acute Asthma attacks in Children who were treated in the emergency department: a controlled comparative study with Oral Prednisolone. J Allergy Clin Immunol. 1998;102:605-9.

Matthews EE, Curtis PD, McLain BI, Morris LS, Turbit ML. Nebulized Budesonide versus oral steroid in severe Exacerbations of Childhood Asthma. Acta Paediatr. 1999;88(8):841-3.

Milani GKM, Rosario Filo NA, Riedi CA, Figueiredo BC. Nebulized Budesonide to treat acute Asthma in Children. J Pediatr (Rio J). 2004;80:106-12.

Gorelick MH, Stevens MW, Schultz T, Scribano PV. Difficulty in obtaining peak expiratory flow measurements in children with acute asthma. Pediatr Emerg Care. 2004;20(1):22-6.

Becker A, Nelson N, Simons F. The Pulmonary Index: Assessment of a clinical Score for Asthma. Am J Dis Child. 1984;38:574-6.






Original Research Articles