Publication: Practical considerations of nebulized corticosteroid in children with acute asthmatic exacerbation: A consensus
Issued Date
2021-09-01
Resource Type
ISSN
22288694
0125877X
0125877X
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2-s2.0-85088615952
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Mahidol University
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SCOPUS
Bibliographic Citation
Asian Pacific Journal of Allergy and Immunology. Vol.39, No.3 (2021), 168-176
Suggested Citation
Chalerat Direkwattanachai, Chalermthai Aksilp, Pantipa Chatchatee, Orathai Jirapongsananuruk, Haruthai Kamalaporn, Wasu Kamchaisatian, Sorasak Lochindarat, Lina Ngamtrakulpanit, Orapan Poachanukoon, Muthita Trakultivakorn, Jamaree Teeratakulpisarn, Kanokporn Udomittipong, Mukda Vangveeravong, Jitladda Deerojanawong Practical considerations of nebulized corticosteroid in children with acute asthmatic exacerbation: A consensus. Asian Pacific Journal of Allergy and Immunology. Vol.39, No.3 (2021), 168-176. doi:10.12932/AP-170918-0407 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77238
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Title
Practical considerations of nebulized corticosteroid in children with acute asthmatic exacerbation: A consensus
Author(s)
Chalerat Direkwattanachai
Chalermthai Aksilp
Pantipa Chatchatee
Orathai Jirapongsananuruk
Haruthai Kamalaporn
Wasu Kamchaisatian
Sorasak Lochindarat
Lina Ngamtrakulpanit
Orapan Poachanukoon
Muthita Trakultivakorn
Jamaree Teeratakulpisarn
Kanokporn Udomittipong
Mukda Vangveeravong
Jitladda Deerojanawong
Chalermthai Aksilp
Pantipa Chatchatee
Orathai Jirapongsananuruk
Haruthai Kamalaporn
Wasu Kamchaisatian
Sorasak Lochindarat
Lina Ngamtrakulpanit
Orapan Poachanukoon
Muthita Trakultivakorn
Jamaree Teeratakulpisarn
Kanokporn Udomittipong
Mukda Vangveeravong
Jitladda Deerojanawong
Abstract
Background: Acute asthmatic exacerbation in children causes economic burdens both directly and indirectly. The GINA guideline does mention the use of inhaled or oral corticosteroids in the treatment of asthmatic exacerbation, it provides little practical guidance on the use of nebulized corticosteroid. Objective: To review and recommend the practical considerations in the use of nebulized corticosteroid in children with acute asthmatic exacerbation. Methods: This consensus was developed by a group of expert pediatricians in respiratory and allergy fields in Thailand. The recommendations were made based on a review of published studies and clinical opinions. The eligible studies were confined to those published in English, and randomized controlled trials and meta-analyses involving nebulized corticosteroids in asthmatic exacerbation in children aged between 1-18 years. Results: There were 13 randomized controlled-trial studies published from 1998 to 2017. Nine of the 13 studies compared nebulized with systemic corticosteroid conducted in moderate to severe exacerbation, while the remaining four compared nebulized corticosteroid with placebo conducted in mild to severe exacerbation. The admission rate was significantly lower in severe exacerbation (one study) and pooled four mild to severe exacerbation studies comparing with placebo (p 0.022). Other clinical parameters were significantly improved with nebulized corticosteroid such as clinical scores, systemic corticosteroid/bronchodilator use, or shorter ER stays. Only one study used fluticasone, while the other 12 studies conducted by budesonide (92.31%). Conclusion: Nebulized corticosteroid may offer an effective therapeutic option for the management of acute exacerbation of asthma in all severities. Nebulized budesonide is the preferred corticosteroid.
