A Delphi consensus on nebulized budesonide for adults with asthma and COPD

Abstract

BACKGROUND: Inhaled corticosteroids (ICS) represent an alternative treatment option to systemic corticosteroids (SCS) in the treatment of asthma and chronic obstructive pulmonary disease (COPD); however, detailed clinical guidance on the use of nebulized ICS, such as budesonide, in the management of asthma and COPD remains scarce. OBJECTIVE: To review the literature and develop Delphi consensus statements on the use of nebulized ICS for the management of asthma and COPD in adults. METHODS: An expert panel of 13 respiratory physicians, comprising pulmonologists (n = 9), allergists (n = 1), and emergency department consultants (n = 3) from tertiary medical centers in Thailand, undertook a Delphi procedure with the aim of developing evidence-based consensus statements on the use of nebulized ICS in patients with asthma and COPD. Panelists used a 5-point Likert scale to score their agreement with each statement. RESULTS: A total of 12 Delphi consensus statements pertaining to the use of nebulized ICS in the management of asthma and COPD in both acute and maintenance care were developed. The overall consensus of the panel across the 12 statements was very high (mean agreement score, 4.2-4.9/5). The panelists expressed strongest consensus agreement (84.6% strong agreement) with the following two statements: 1) inhalation devices are the cornerstone of drug delivery in patients with asthma and COPD, and 2) for adult asthma and COPD patients with severe exacerbations, nebulization is more suitable for drug delivery than a pMDI plus spacer. CONCLUSIONS: Nebulized budesonide is an effective and well tolerated treatment option for the management of asthma and COPD.