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Adding Inhaled Budesonide to Oral Corticosteroids Decreases Asthma Relapse

Several studies comparing use of oral and inhaled corticosteroids after ED discharge for asthma proclaim equivalence. This is the first study to examine whether the addition of inhaled corticosteroids to oral corticosteroids is beneficial.

In this double-blind, randomized trial conducted at a community teaching ED in Ontario, 1,006 consecutive evaluable patients met the eligibility requirements of age 16 to 60 years and PEFR less than 80%. After exclusion, mainly for recent steroid use, 188 patients met the study criteria. Of these, 94 received budesonide (800 µg twice per day for 21 days) and 94 received an indistinguishable placebo; all received oral prednisone (50 mg per day for 7 days).

At 21 days, the addition of inhaled corticosteroids had reduced the rate of relapse (12.8% vs. 24.5%; p=0.049), improved all four Asthma Quality of Life Questionnaire scores (p=0.001), and reduced beta agonist use (p=0.01). PEFRs were worse in the combined-therapy group at baseline but comparable at study end. Adverse effects thought to be associated with inhaled corticosteroids, such as insomnia and fluid retention, were comparable between the two groups.

Comment: This beautifully composed trial provides compelling data that inhaled corticosteroids enhance the anti-inflammatory value of oral corticosteroids in the management of asthma patients discharged from the ED. It does not address whether the duration of inhaled corticosteroids should be longer or shorter than three weeks or whether oral corticosteroids can be reduced or eliminated safely.

— JA Marx

Published in Journal Watch Emergency Medicine August 1, 1999

Citation(s):

Rowe BH et al. Inhaled budesonide in addition to oral corticosteroids to prevent asthma relapse following discharge from the emergency department. JAMA 1999 Jun 9 281 2119-2126.

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