PURPOSE: To assess the utility of inhaled corticosteroids for the early management of acute exacerbations of asthma in the emergency room.
METHODS: This randomized, double-blind, placebo-controlled study was conducted to evaluate the efficacy of high dose inhaled fluticasone with frequent beta-2-agonist therapy in patients of acute moderate exacerbations of asthma. Eighty patients between 15 and 45 years of age with acute moderate exacerbations of asthma were put on aerosolized 500 [micro]g of fluticasone at half hourly intervals for three doses with metered dose inhaler and zero stat "V" spacer. All patients received humidified oxygen and nebulized salbutamol (0.15 mg/kg in 3 ml saline) prior to fluticasone administration. The control group received placebo instead of inhaled fluticasone. Patients who had received corticosteroids in the preceding 72 h were excluded from the study. If there was an inadequate response or no response to treatment at the end of 2 hour, oxygen and salbutamol therapy were continued and given one dose of intravenous hydrocortisone and was started on an aminophylline infusion.
RESULTS: Both fluticasone and control group showed a significant improvement in respiratory status at the end of 2 h. However, patients in the fluticasone group showed greater improvement in PEFR (P < 0.05) and significantly lower proportion of patients required oxygen improvement in PEFR (P < 0.01). The length of stay was significantly shorter in the fluticasone group than in the placebo group (P < 0.01).
CONCLUSION: Aerosolized fluticasone therapy with MDI and spacer together with salbutamol in the treatment of acute exacerbations of asthma helped in early recovery and decreased hospital stay.
CLINICAL IMPLICATIONS: Inhaled fluticasone may be given with MDI and spacer in the treatment of acute exacerbations of asthma.
DISCLOSURE: Sudhir Agarwal, None.
Sudhir K. Agarwal MD * Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group