Dane EDİGER, Ercüment EGE, Gürdal Eser YÜKSEL, Kunt Esra UZASLAN, Funda COŞKUN, Oktay GÖZÜ, Mehmet KARADAĞ

Clinical effectiveness of nebulised budesonide in the treatment of acute asthma attacks

Akut astım tedavisinde kullanılan nebülize budesonid (NB) topikal antiinflamatuvar etki sağlayabilir ve sistemik kortikosteroidlere (SC) alternatif olabilir. Bu çalışmada, akut astımı olan erişkin hastalarda NB ile SC’nin akciğer fonksiyonları ve klinik bulgular üzerine olan etkisinin karşılaştırılması amaçlanmıştır. Kliniğimize akut astım tanısı ile yatırılan 30 hasta (K/E: 26/4; ortalama yaş= 47.1 ± 2.1 yıl) çalışmaya alındı. Hastalar üç gruba ayrıldı; Grup I yalnızca NB ile tedavi edildi (4 mg/gün), Grup II yalnızca SC ile (1 mg/kg/gün metilprednizolon), Grup III NB ile birlikte SC aldı. Solunum fonksiyonları ve solunum semptom skorları çalışmanın başında ve yedi gün boyunca her sabah ölçüldü ve kaydedildi. Solunum fonksiyon parametreleri tüm gruplarda çalışmanın yedinci gününde başlangıca göre anlamlı şekilde artış gösterdi (p< 0.05), gruplar arasında anlamlı fark saptanmadı (p> 0.05). FEV1 % beklenen düzeyleri Grup I ve III’te ilk günden itibaren istatistiksel olarak anlamlı artış gösterirken (p< 0.05), Grup II’de beşinci güne kadar anlamlı değişiklik bulunmadı. Ortalama semptom skorları Grup I’de ikinci günde, diğer iki grupta ise dördüncü günde istatistiksel yönden anlamlı şekilde azaldı (p< 0.05). Akut astım atağı ile hastaneye yatan hastalarda SC olsun ya da olmasın verilen NB tedavisi, hava yolu obstrüksiyonunu ve semptomları tedavinin ilk gününde düzeltmekte ve bu etkisi yedi gün devam etmektedir. NB’nin güvenilirliğine ve SC ile karşılaştırılabilir etkilerine bakıldığında orta-ağır şiddetteki astım ataklarında alternatif bir tedavi olarak düşünülebilir.

Akut astım atağı tedavisinde nebülize budesonidin klinik etkinliği

Nebulized budesonide (NB) might offer topical anti-inflammatory activity and be an alternative to systemic corticosteroid (SC) in the treatment of acute asthma. The aim of this study was to compare the effect of NB with SC on lung function and clinical findings of adult patients with acute asthma. Thirty patients admitted to clinic with asthma attack (F/M: 26/4; mean age: 47.1 ± 2.1 years) were enrolled to the study. The patients were randomized into three groups; Group I were treated with NB alone (4 mg/day), Group II SC alone (1 mg/kg/day methylprednisolone), Group III NB plus SC. Pulmonary functions and respiratory symptom scores were measured and recorded before and during 7 days of study. Spirometric parameters significantly improved in all groups at 7th day significantly (p< 0.05) without a difference among groups (p> 0.05). FEV1 % levels increased significantly at the first day of study in Group I and III (p< 0.05), but didn’t change in Group II until 5th day of study. The mean symptom scores decreased significantly at the second day in Group I (p< 0.05), and at the 4th day in other groups. NB with or without SC improved successfully airway obstruction and symptoms in patients hospitalized with acute asthma attack as the 1st treatment day in comparison with SC alone and this effect lasted for 7 days. Regarding the superior safety profile and comparable efficacy with SC, NB might be an alternative to the patients with moderate-severe asthma attacks.

PDF

___

1. American Thoracic Society: Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease and asthma. Am Rev Respir Dis 1987; 136: 225-43.
2. Expert Panel Report 2. Guidelines for the Diagnosis and Management of Asthma: National Heart, Lung, and Blood Institute, National Institutes of Health. Bethesda, Maryland, USA. Publication no. 97-4051, July 1997.
3. Morice AH, Morris D, Lawson-Matthew PA. Comparison of nebulized budesonide with oral prednisolone in the treatment of exacerbation of obstructive pulmonary disease. Clin Pharmacol Ther 1996; 60: 675-8.
4. Maltais F, Ostinelli J, Bourbeau J, et al. Comparison of nebulized budesonide and oral prednisolone with placebo in the treatment of acute exacerbations of chronic obstructive pulmonary disease. Am J Rev Respir Crit Care Med 2002; 165: 698-703.
5. Beasley R, Sterk PJ, Kerstjens HA, Decramer M. Comparative studies of inhaled corticosteroids in asthma. Eur Respir J 2001; 17: 579-80.
6. Higenbottam TW, Britton J, Lawrence D, et al. Comparison of nebulized budesonide and prednisolone at severe asthma exacerbation in adults. Bio Drugs 2000; 14: 247-54.
7. O’Connell EJ. Review of the unique properties of budesonide. Clin Ther 2003; 25 (Suppl C): C42-60.
8. Devidayal D, Singhi S, Kumar L, Jayshree M. Efficacy of nebulized budesonide compared to oral prednisolone in acute bronchial asthma. Acta Paediatr 1999; 88: 835-40.
9. Wennergren G, Nordvall SL, Hedlin G, et al. Nebulized budesonide for the treatment of moderate to severe asthma in infants and toddlers. Acta Paediatr 1996; 85: 183-9.
10. Ilangovan P, Pedersen S, Godfrey S, et al. Treatment of severe steroid dependent preschool asthma with nebulized budesonide suspension. Arch Dis Child 1993; 68: 356-9.
11. Kemp JP, Skoner DP, Szefler SJ, et al. Once-daily budesonide inhalation suspension for the treatment of persistent asthma in infants and young children. Ann Allergy Asthma Immunol 1999; 83: 231-9.
12. Szefler SJ, Eigen H. Budesonide inhalation suspension: A nebulized corticosteroid for persistent asthma. J Allergy Clin Immunol 2002; 109: 730-42.
13. Singhi SC, Banerjee S, Nanjundaswamy HM. Inhaled budesonide in acute asthma. J Paediatr Child Health 1999; 35: 483-7.
14. Nuhoglu Y, Bahceciler NN, Barlan IB, Mujdat Basaran M. The effectiveness of high dose inhaled budesonide therapy in the treatment of acute asthma exacerbations in children. Ann Allergy Asthma Immunol 2001; 86: 318-22.
15. Wilson AM, Mc Farlane LC, Lipworth BJ. Systemic bioactivity profiles of oral prednisolone and nebulized budesonide in adult asthmatics. Chest 1998; 114: 1022-7.
16. Otulana BA, Varma N, Bullock A, Higenbottam T. High dose nebulized steroid in the treatment of chronic steroid- dependent asthma. Respir Med 1992; 86: 105-8.
17. Higenbottam TW, Clark RA, Luksza AR, et al. The role of nebulized budesonide in permitting a reduction in the dose of oral steroid in persistent severe asthma. Eur J Clin Res 1994; 5: 1-10.
18. O’Connor BJ, Basran GS, O’Connell F, O’Shaughnessy KM. Oral steroid sparing effect of nebulized budesonide in chronic severe asthma. Am J Respir Crit Care Med 1996; 153 (No 4 Pt 2): A341.
19. Hvizdos KM, Jarvis B. Budesonide inhalation suspension: A review of its use in infants, children and adults with inflammatory respiratory disorders. Drugs 2000; 60: 1141-78.
20. Mitchell CA, Alpers JH, Morton SM, et al. Comparison of nebulized budesonide with oral prednisolone in the treatment of severe acute asthma. Eur Respir J 1995; 8 (Suppl 19): 490.
21. Rowe BH, Bota GW, Fabris L, et al. Inhaled budesonide in addition to oral corticosteroids to prevent asthma relapse following discharge from the emergency department: A randomized controlled trial. JAMA 1999; 281: 2119-26.
22. Rodrigo C, Rodrigo G. Inhaled flunisolide for acute severe asthma. Am J Respir Crit Care Med 1998; 157: 698-703.
23. Rodrigo GJ, Rodrigo C. Triple inhaled drug protocol for the treatment of acute severe asthma. Chest 2003; 123: 1908-15.
24. McFadden ER. Inhaled corticosteroids and acute asthma: Therapeutic breakthrough or nonspecific effect? Am Rev Respir Crit Care Med 1998; 157: 677-8.