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The role of nebulised budesonide in the treatment of exacerbations of COPD

Dept of Pulmonary Medicine, Turgut Ozal Research Centre, Inonu University, Malatya, Turkey.

CORRESPONDENCE: H. Gunen, Dept of Pulmonary Medicine, Turgut Ozal Research Centre, Inonu University, Malatya 44069, Turkey. Fax: 90 4223410728. E-mail: hgunen{at}yahoo.com

Keywords: Chronic obstructive pulmonary disease, exacerbation, nebulised budesonide, systemic corticosteroid

Received: June 5, 2006
Accepted January 8, 2007

The present study was designed to evaluate the hypothesis that nebulised budesonide (NB) might be an alternative to systemic corticosteroids (SC) in the treatment of patients with exacerbations of chronic obstructive pulmonary disease (ECOPD).

Patients hospitalised with ECOPD (n = 159) were randomised into three groups. Group 1 received only standard bronchodilator treatment (SBDT), group 2 received SC (40 mg prednisolone) plus SBDT, and group 3 received NB (1,500 µg q.i.d.) plus SBDT. Improvement during 10-day hospitalisation was compared with exacerbation and rehospitalisation rates after discharge.

While mean±SD age was 64.1±8.9 yrs (female/male = 0.1), mean forced expiratory volume in one second (FEV₁) at admission was found to be 37.2±12.2% predicted. Arterial blood gases and spirograms recovered faster in groups 2 and 3. While improvements in arterial oxygen tension (P_a,O2) and forced vital capacity (FVC) in group 2, and improvements in P_a,O2, FVC and FEV₁ in group 3, became significant at 24-h control, the first significant improvement in group 1 appeared in arterial oxygen saturation at 72-h control. The mean improvement of P_a,O2 after 10 days was 1.20 and 1.06 kPa (9 and 8 mmHg) higher in group 2 and 3, respectively, than in group 1. Blood glucose exhibited an upward trend only in group 2.

The study demonstrates that nebulised budesonide may be an effective and safe alternative to systemic corticosteroids in the treatment of exacerbations of chronic obstructive pulmonary disease.

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