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Paediatric Asthma Clinic and Asthma Research Laboratories, Schneider Childrens Medical Center, 14 Kaplan Street, Petach
Tikva, 49202 Israel
Received 15 May 2006; accepted 6 October 2006
KEYWORDS
Budesonide;
Acute asthma;
Efcacy
Summary
The use of systemic corticosteroids, together with bronchodilators and oxygen therapy, has
become established for the management of acute asthma. These agents are undoubtedly
effective, but are also associated with problems such as metabolic adverse effects. Inhaled
corticosteroids (ICS) offer potential benet in the acute setting because they are delivered
directly to the airways. They are also likely to reduce systemic exposure, which would lead
in turn to reductions in rates of unwanted systemic effects. In order to evaluate the role of
budesonide in the management of acute asthma exacerbations we conducted a review of
the literature and critically evaluated the rationale for the use of ICS in general in this
setting.
Trials in adults and children requiring treatment for acute exacerbation of asthma have
shown clinical and/or spirometric benet for budesonide when delivered via nebulizer, dry
powder inhaler, or aerosol in the emergency department, hospital and follow-up settings.
The efcacy seems to benet from high doses given repeatedly during the initial phase of
an acute exacerbation. These acute effects are likely to be linked to the drugs distinctive
pharmacokinetic and pharmacodynamic prole. The current evidence base revealed
encouraging results regarding the efcacy of the ICS budesonide in patients with wheeze
and acute worsening of asthma. Future studies should focus on the efcacy of these agents
in more severe asthma worsenings.
& 2006 Elsevier Ltd. All rights reserved.
ARTICLE IN PRESS
0954-6111/$ - see front matter & 2006 Elsevier Ltd. All rights reserved.
doi:10.1016/j.rmed.2006.10.009
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