Comparison of the efficacy of nebulised budesonide with parenteral corticosteroids in the treatment of acute exacerbations of chronic obstructive pulmonary disease.

OBJECTIVE To compare the efficacy and safety of nebulised budesonide and systemic corticosteroid in the treatment of acute exacerbations of chronic obstructive pulmonary disease (COPD). DESIGN Randomised, double-blind, placebo-controlled, parallel-group trial. PATIENTS AND INTERVENTIONS A total of 40 patients who had moderate to severe acute exacerbations of COPD and required hospitalisation were enrolled in the study. The patients were randomised to receive either nebulised budesonide 8mg daily (n = 21) or systemic (intravenous) prednisolone 40mg daily (n = 19). Airway obstruction (peak expiratory flow rate [PEFR]) and gas exchange (arterial partial pressure of oxygen [PaO(2)] and carbon dioxide [PaCO(2)], pH and oxygen saturation [SaO(2)]) were evaluated at 30 min, at 6, 24 and 48 hours, and at day 10. RESULTS There were no significant differences between groups at baseline. In both groups, differences were significant for PEFR, SaO(2) and PaO(2) (p < 0.001), but not for PaCO(2) and pH, in comparison with their baseline values. There were no significant differences between groups for all parameters (PEFR, PaO(2), PaCO(2), pH and SaO(2)) at all time periods. No adverse events were recorded in either group. CONCLUSIONS Our study suggests that nebulised budesonide may be an alternative to parenteral corticosteroids in the treatment of acute exacerbations of COPD.