Background Asthma is one of the most common chronic respiratory diseases in children and a major cause of emergency department visits and hospital admissions. Acute asthma exacerbations are characterized by worsening airway obstruction due to bronchoconstriction, mucosal edema, and airway inflammation. Short-acting beta-2 agonists, such as salbutamol, are the cornerstone of acute management because of their rapid bronchodilator effect. However, airway inflammation plays a central role in exacerbations, and corticosteroids are essential to control this inflammatory process. While systemic corticosteroids are well established in moderate to severe exacerbations, the role of inhaled corticosteroids, particularly nebulized budesonide, in the acute setting of mild-to-moderate pediatric asthma exacerbations remains controversial. This has led to ongoing research to determine whether adding nebulized budesonide to salbutamol provides additional short-term clinical benefit. Aim The aim of this study was to compare the clinical effectiveness of nebulized salbutamol alone versus nebulized salbutamol combined with nebulized budesonide in the management of mild-to-moderate acute asthma exacerbations in children. A secondary aim was to evaluate the usefulness of the Pulmonary Index Score (PIS) as a reliable and practical tool for assessing the severity of asthma exacerbations and monitoring clinical improvement over time. Patients and methods This prospective, randomized, comparative clinical study included 120 children aged 2–12 years who presented with mild-to-moderate acute asthma exacerbations to the Emergency Department of Alexandria University Children’s Hospital. Patients were classified according to the PIS and randomly allocated into two equal groups. Group A received nebulized salbutamol alone, while group B received nebulized salbutamol combined with high-dose nebulized budesonide. Exclusion criteria included severe asthma exacerbation, chronic lung or cardiac disease, and suspected bronchiolitis. All patients underwent standardized clinical assessment at baseline and at 30, 60, and 90 min after treatment, including respiratory rate, oxygen saturation, use of accessory muscles, wheeze intensity, inspiratory-expiratory ratio, and PIS. The primary outcome was improvement in PIS, while secondary outcomes included changes in respiratory rate and oxygen saturation. Statistical analysis was performed using appropriate nonparametric tests, with significance set at P less than or equal to 0.05. Results The two study groups were comparable regarding demographic characteristics, asthma history, inhaler use, baseline asthma severity, and previous exacerbation outcomes, with no statistically significant differences. Both treatment regimens resulted in clinical improvement over time; however, the group receiving nebulized salbutamol plus budesonide demonstrated a more rapid and greater reduction in PIS compared with the salbutamol-only group, particularly at 60 and 90 min after treatment. This group also showed a more pronounced improvement in respiratory rate and oxygen saturation. The PIS proved to be a sensitive and practical tool for detecting changes in clinical status during acute exacerbations. No serious adverse effects related to nebulized budesonide were observed during the study period. Conclusions The addition of nebulized budesonide to nebulized salbutamol in the treatment of mild to moderate acute asthma exacerbations in children leads to faster and greater clinical improvement compared with salbutamol alone. This combined therapy appears to be safe and effective in the acute setting. The PIS is a reliable, simple, and noninvasive method for assessing asthma exacerbation severity and monitoring response to treatment. Incorporating nebulized inhaled corticosteroids as an adjunct to bronchodilator therapy may be beneficial in selected pediatric patients with acute asthma exacerbations.
Gabal et al. (Thu,) studied this question.
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