PURPOSE:To assess the utility of inhaled corticosteroids for the early management of acute exacerbations of asthma in the emergency room.
METHODS:This randomized, 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. Sixty patients between 15 and 40 years of age with acute moderate exacerbations of asthma were put on aerosolized 500 μg of fluticasone plus 50 μg of salmeterol (fluticasone group) at half hourly intervals for three doses with metered dose inhaler and 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 plus salmeterol 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 plus salmeterol may be given with MDI and spacer in the treatment of acute exacerbations of asthma.
DISCLOSURE:Sudhir Agarwal, None.