The additive benefit of inhaled corticosteroid when used with systemic corticosteroid in acute asthma is still unclear. The objective of this study was to assess the effect of high and repeated doses of inhaled budesonide when combined with the standard treatment of adult acute asthma. It was a prospective double-blind randomized controlled study performed in the emergency department (ED) from May 1, 2010 to February 28, 2011 (ClinicalTrials.gov, NCT04016220). Fifty patients were included and were randomized to receive intravenous hydrocortisone hemisuccinate in association with nebulized budesonide (n = 23, budesonide group) or normal saline (n = 27, control group). Nebulization of budesonide or saline was done in combination with 5 mg of terbutaline every 20 min the first hour, then at 2 h (H2), and 3 h (H3). All patients received standard treatment. Efficacy and safety of inhaled budesonide were evaluated every 30 min for 180 min. A significant increase in peak expiratory flow (PEF) was observed in both treatment groups at evaluation times. The increase in PEF persisted significantly compared to the previous measurement in both groups. There was no significant difference in the PEF between the two groups at evaluation times. There was no significant difference between the two groups in the evolution in the respiratory rate and heart rate. There was also no statistically significant difference between the two groups in the rate of hospitalization, the discharge criteria before the end of the protocol. Considering its limited power, our study suggests that the association of nebulized budesonide with hydrocortisone hemisuccinate has no additional effect over the use of hydrocortisone alone in adults’ acute asthma managed in the ED.

中文翻译：

---

雾化布地奈德联合全身性皮质类固醇与单独全身性皮质类固醇治疗急诊科治疗的急性重症哮喘：一项随机对照试验


吸入性皮质类固醇与全身性皮质类固醇一起用于治疗急性哮喘时的附加益处尚不清楚。本研究的目的是评估高剂量和重复剂量吸入布地奈德与成人急性哮喘标准治疗相结合的效果。这是2010年5月1日至2011年2月28日在急诊科（ED）进行的一项前瞻性双盲随机对照研究（ClinicalTrials.gov，NCT04016220）。纳入 50 名患者，并随机接受静脉注射氢化可的松半琥珀酸酯联合雾化布地奈德（n = 23，布地奈德组）或生理盐水（n = 27，对照组）。布地奈德或盐水与 5 mg 特布他林联合雾化，第一小时每 20 分钟一次，然后是 2 小时 (H2) 和 3 小时 (H3)。所有患者均接受标准治疗。在 180 分钟内每 30 分钟评估一次吸入布地奈德的疗效和安全性。在评估时，两个治疗组均观察到呼气峰流量 (PEF) 显着增加。与之前的测量相比，两组的 PEF 持续显着增加。评估时两组之间的 PEF 无显着差异。两组之间呼吸频率和心率的演变没有显着差异。两组之间在住院率、方案结束前的出院标准方面也没有统计学上的显着差异。考虑到其功效有限，我们的研究表明，对于急诊科治疗的成人急性哮喘，雾化布地奈德与氢化可的松半琥珀酸酯的联合使用并没有比单独使用氢化可的松产生额外的效果。