Comparison of Nebulized Versus Systemic Corticosteroids for Management of Children Presenting with Acute Exacerbation of Asthma

Silwana Taroni; Shakeel Ahmed; Wahid Nawaz; Andleeb Tariq; Fatima Raza; Abdullah

doi:10.51253/pafmj.v76i3.13458

Authors

Silwana Taroni Department of Pediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Shakeel Ahmed Department of Pediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Wahid Nawaz Department of Pediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Andleeb Tariq Department of Pediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Fatima Raza Department of Pediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan
Abdullah Department of Pediatrics, Combined Military Hospital/National University of Medical Sciences (NUMS), Rawalpindi Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76i3.13458

Keywords:

Acute Asthma Exacerbation, Airway Resistance, Nebulized Corticosteroids, Systemic Corticosteroids

Abstract

Objective: To compare the efficacy of Nebulized versus Systemic Corticosteroids in the management of children presenting with acute exacerbation of asthma.

Study Design: Quasi-experimental study.

Place and Duration of Study: Department of Pediatrics, Combined Military Hospital, Rawalpindi Pakistan, from Feb to May 2024.

Methodology: A total of 60 pediatric patients with acute asthma exacerbations were enrolled using non-probability consecutive sampling. Group-I (Nebulized Corticosteroids) and Group-II (Systemic Corticosteroids). Group-I received Nebulized Budesonide, while Group-II received Oral or Intravenous Corticosteroids (Prednisolone or Hydrocortisone). The primary outcome was the change in oscillometric airway resistance at 20 Hz (R20), measured at baseline and on Day 14 using the Impulse Oscillometry System (IOS). Data were analyzed using SPSS version 26, with statistical significance set at p<0.05.

Results: The R20 baseline values (p=0.02) and symptom scores (p=0.01) were significantly different. The Nebulized-Group had a greater severity. After 14 days, all groups improved in R20 and symptom score, and the systemic Corticosteroid-Group had a greater reduction in airway resistance and symptom severity (p=0.001) than the Nebulized-Group. Both treatments produced clinically significant improvements, although the systemic corticosteroid resulted in a greater effect on airway resistance and symptom severity.

Conclusion: Both Nebulized and Systemic Corticosteroids produce clinically significant improvements in acute exacerbation of asthma in children. The Systemic Corticosteroids produced a greater reduction in R20, and the Nebulized Corticosteroids produced better symptom control.

Downloads

Download data is not yet available.

References

1. Garg R, Piplani M, Singh Y, Bhateja P, Rana R. An overview of integrated risk factors with prevention and prevalence of asthma at the global level. Curr Trad Med 2024; 10(4): 71-81.

https://doi.org/10.2174/2215083810666230525153908

2. Song P, Adeloye D, Salim H, Dos Santos JP, Campbell H, Sheikh A, et al. Global, regional, and national prevalence of asthma in 2019: a systematic analysis and modelling study. J Glob Health 2022; 12: 04052. https://doi.org/10.7189/jogh.12.04052

3. Khan S, Iqbal S, Azam A, Qadeer S, Khanam S. Prevalence and determinants of Asthma in adults in Khyber Pakhtunkhwa, Pakistan. Abasyn J Life Sci 2022; 5(2): 26-32.

https://doi.org/10.34091/AJLS.5.2.4

4. Iqbal MZ, Alqahtani SS, Shahid S, Mubarak N. Socio-demographic, environmental and clinical factors influencing asthma control in community pharmacies of Lahore Pakistan. Sci Rep 2025; 15(1): 10587.

https://doi.org/10.1038/s41598-025-95373-4

5. Gershkovich D. Acute exacerbation of asthma. Masters Thesis. University of Zagreb, School of Medicine; 2023.

https://urn.nsk.hr/urn:nbn:hr:105:749372

6. Leung JS. Paediatrics: how to manage acute asthma exacerbations. Drugs Context 2021; 10: 2020-12-7.

https://doi.org/10.7573/dic.2020-12-7

7. Marghli S, Bouhamed C, Sghaier A, Chebbi N, Dlala I, Bettout S, et al. Nebulized budesonide combined with systemic corticosteroid vs systemic corticosteroid alone in acute severe asthma managed in the emergency department: a randomized controlled trial. BMC Emerg Med 2022; 22(1): 134.

https://doi.org/10.1186/s12873-022-00691-9

8. Altube MJ, Perez N, Romero EL, Morilla MJ, Higa LH, Perez AP. Inhaled lipid nanocarriers for pulmonary delivery of glucocorticoids: Previous strategies, recent advances and key factors description. Int J Pharm 2023; 642: 123146.

https://doi.org/10.1016/j.ijpharm.2023.123146

9. Liang X, Zheng J, Gao Y, Zhang Z, Han W, Du J, et al. Clinical application of oscillometry in respiratory diseases: an impulse oscillometry registry. ERJ open Res 2022; 8(4): 00080-2022.

https://doi.org/10.1183/23120541.00080-2022

10. Rao SK. Management of Asthma & Its Exacerbations in smaller settings, International J Clin Rep Stud 2023; 2(6): 2-8.

https://doi.org/10.31579/2835-8295/041

11. Gurnell M, Heaney LG, Price D, Menzies‐Gow A. Long‐term corticosteroid use, adrenal insufficiency, and the need for steroid‐sparing treatment in adult severe asthma. J Intern Med 2021; 290(2): 240-256.

https://doi.org/10.1111/joim.13273

12. Imtiaz R, Yameen S, Hassan A, Ramzan H, Nizami S, Ayub Z. Clinical Efficacy Of Dexamethasone Versus Hydrocortisone In Acute Exacerbation Of Asthma In Children. Pak J Intensive Care Med 2025; 5(01): 35. https://doi.org/10.54112/pjicm.v4i02.35

13. Hasegawa K, Craig SS, Teach SJ, Camargo Jr CA. Management of asthma exacerbations in the emergency department. J Allergy Clin Immunol Pract 2021; 9(7): 2599-2610.

https://doi.org/10.1016/j.jaip.2020.12.037

14. Baqdunes MW, Leap J, Young M, Kaura A, Cheema T. Acute exacerbation of chronic obstructive pulmonary disease. Crit Care Nurs Q 2021; 44(1): 74-90.

https://doi.org/10.1097/cnq.0000000000000341

15. Ahmadi Afshar A, Rahmati M, Maleki A, Kamali K. The Effectiveness of Budesonide in the Treatment of Asthma Attacks in Children: A Systematic Review and Meta-Analysis. Prev Care Nurs Midwifery J 2023; 13(3): 9-18.

http://doi.org/10.61186/pcnm.13.3.9

16. Direkwattanachai C, Aksilp C, Chatchatee P, Jirapongsananuruk O, Kamalaporn H, Kamchaisatian W, et al. Practical considerations of nebulized corticosteroid in children with acute asthmatic exacerbation: A consensus. Asian Pac J Allergy Immunol 2021; 39(3): 168-176.

https://doi.org/10.12932/ap-170918-0407

17. Papadopoulou E, Safar SB, Khalil A, Hansel J, Wang R, Corlateanu A, et al. Inhaled versus systemic corticosteroids for acute exacerbations of COPD: a systematic review and meta-analysis. Eur Respir Rev 2024; 33(171): 230151.

https://doi.org/10.1183/16000617.0151-2023

18. Zineldin MA. Systemic Corticosteroids with or without Nebulized Budesonide for Treatment of Acute Severe Asthma Exacerbations in the Emergency Room: A retrospective Study. Int J Med Arts 2024; 6(11): 5116-5121.

https://doi.org/10.21608/ijma.2024.333093.2063