Inhaled Budesonide in Addition to Oral Corticosteroids to Prevent Asthma Relapse Following Discharge From the Emergency Department

摘要: ContextRelapses of acute asthma following emergency department (ED) discharge can be reduced with systemic corticosteroid treatment. However, whether inhaled corticosteroids (ICSs) provide additional benefit is not known.ObjectiveTo determine the addition ICSs to oral corticosteroid treatment would reduce relapses in patients acute asthma discharged from ED.Design and SettingPlacebo-controlled, double-blind, randomized clinical trial conducted a community teaching hospital ED Canada between November 1995 September 1997, 21-day follow-up.ParticipantsA total 1006 consecutive aged 16 60 years presented asthma; after excluding those using oral and/or as well those meeting other exclusion criteria, 188 were included study.InterventionsPatients nontapering course of prednisone (50 mg/d) for 7 days. In double-blind fashion, patients randomly assigned 1600 µg/d budesonide (n=94) or identical placebo (n=94) for 21 days.Main Outcome MeasuresIncidence relapse, defined an unscheduled visit worsening symptoms, budesonide vs placebo groups. Secondary outcomes response Asthma Quality Life Questionnaire, β2-agonist use, symptom score, global improvement assessment, pulmonary function.ResultsFive group 3 placebo group either dropped out lost follow-up but in primary analyses. After 21 days, 12 (12.8%) 94 the budesonide experienced relapse compared 23 (24.5%) 94 in group, 48% reduction (P=.049). Asthma Quality Questionnaire scores higher (better quality) group (P=.001), all domain scores (P=.001 .01). Fewer β2-agonist activations used at end trial by receiving (2.4/d vs 4.2/d; P=.01). Symptom .004) self-assessed asthma improvement scores (based on 7-point Likert scale) (6.2 5.2; P<.001) (indicating fewer symptoms) for budesonide placebo. There no differences function between groups (peak expiratory flow rate: budesonide, 437 vs placebo, 453 L/min; P=.39) Using this approach, few 9 require prevent 1 relapse.ConclusionsPatients treatment for added high-dose inhaled budesonide days corticosteroids alone.