INHALATIONAL STEROID IN ASTHMA EXACERBATION,DK JHA
The corrent recommendation for the treatment of acute exacerbation of asthma is to give short acting beta agonist(salbutamol) inhalation through various devices as frequently as every 20 minutes if needed or every 4 hourly if there is no symptom in that interval,in other way if bronchodilatation sustains for 4 hours.After 24 hours of this therapy,if symptom persists due to airflow limitation,systemic steroid should be given orally or in injectable form if the child vomits or not able to take orally.
Inhalational steroid is given as controller medication for persistent asthma.It takes 2 to 4 weeks for controlling asthma on regular inhalational steroid in appropriate dose with correct inhalational technique.
DR.Mari Sago from Haga Red cross Hospital ,Tochigi Japan,presented his study in a poster presentaion in annual meeting of American Academy of Allergy,Asthma and immunology on 9 March 2016 at Los Angeles.
Dr Sago and his colleagues randomized 50 children with moderate exacerbation of asthma aged 8 months to 35 months into two groups.
One group received high dose budesonide ,1 mg ,twice daily through nebulizer and the other received intravenous prednisolone 8 hourly.Doses were tapered in both group when there was no wheezing.Serum cortisol level was estimated at start and then at the end of steroid therapy in both groups.The number of days of wheezing and hospital stay were similar in both groups(5days), but use of oxygen was less in the group on inhalational high dose budesonide. Cortisol suppression was less in the group on high dose inhalational budesonide.
My view-If this study will be done on large sample size with expanded age range at various centres of the world,it will be very convenient for the child,parents and treating physician.