Inhaled High Dose Budesonide Is As Effective As Systemic Corticosteroids for Children Under Three with Mild Asthma Exacerbations

Rationale: Recurrent wheezing in children under three years of age is commonly associated with viral infections. The pathogen is different from that which causes allergen-induced asthma, usually in school-aged children. Both high-dose inhaled corticosteroids and systemic corticosteroids are efficacious in the treatment of children with allergen-induced asthma who have mild to severe exacerbations. The aim of this study is to compare the efficacy and safety of high-dose inhaled corticosteroids with systemic corticosteroids in children under three years of age with mild asthma exacerbations.

Methods: A randomized controlled study of children admitted with mild asthma exacerbations was conducted from April 2013 to November 2014. Patients were divided into two groups and treated with either inhaled high dose corticosteroids (BIS, n=30) or systemic corticosteroids (PSL, n=20), nebulized budesonide 1.0mg/dose, twice daily, and prednisolone 0.5mg/kg iv, every eight hours. A clinical score, including wheezing and asthma symptoms, was recorded daily. Serum cortisol concentration was measured during the hospital stay.

Results: Fifty children with asthma exacerbations, ages 8-35months, were included in this study. The clinical scores and length of stay were not significantly different between the groups. Serum cortisol concentration was similar on admission (BIS 15.0µg/dL, PSL 17.2µg/dL, p>.05), but there was a significant decrease in serum cortisol concentration in children receiving systemic corticosteroids after four days of treatment (BIS 17.0µg/dL, PSL 10.9µg/dL, p=.0036).

Conclusions: In hospitalized children under age three with mild asthma exacerbations, inhaled high dose corticosteroids are at least as effective as systemic corticosteroids, without suppressing serum cortisol levels.