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A Randomized Controlled Trial of Inhaled Flunisolide in the Management of Acute Asthma in Children^*

^* From the Department of Pediatrics (Dr. Nakanishi), St. Louis University School of Medicine, St. Louis, MO; Department of Pediatrics (Dr. Klasner), University of Alabama-Birmingham, Birmingham, AL; and Department of Pediatrics (Dr. Rubin), Wake Forest University School of Medicine, Winston-Salem, NC.

Correspondence to: Albert K. Nakanishi, MD, Associate Professor of Pediatrics, St. Louis University School of Medicine, Cardinal Glennon Children’s Hospital, 1465 S. Grand Blvd, St. Louis, MO 63119; e-mail: Nakanimk{at}slu.edu

Background: Inhaled corticosteroids (ICS) may provide benefit in the therapy of acute asthma. The purpose of this study was to test the hypothesis that ICS are as effective as oral corticosteroids (OCS) in the management of acute childhood asthma.

Methods: A randomized, masked, placebo-controlled study was conducted in children aged 6 to 16 years seeking emergent care for an acute exacerbation of asthma. Patients were randomized into one of two groups: group 1 (OCS), oral prednisone, 2 mg/kg (maximum of 60 mg/d) for 7 days, and placebo pressurized metered-dose inhaler with valved holding chamber, four inhalations bid; and group 2 (ICS), flunisolide, four inhalations (1 mg) bid for 7 days, and daily placebo tablets. Spirometry (FEV₁) was performed at baseline, day 3, and day 7 of the study. A symptom diary and twice-daily peak expiratory flow were recorded.

Results: A total of 58 subjects receiving ICS (n = 27) or OCS (n = 28) were enrolled. Baseline asthma severity, race, gender, and age were balanced between the two groups. ² showed no significant difference in symptom severity between the two groups at any time during the study. FEV₁ percentage of predicted was lower in the ICS group on day 3 (65% vs 78%, p = 0.03) and on day 7 (77% vs 95%, p = 0.002).

Conclusion: ICS were found to be useful in the management of acute asthma in children; however, spirometry data suggested a more rapid resolution of asthma with OCS.

Key Words: acute childhood asthma • inhaled corticosteroids • metered-dose inhaler • oral corticosteroids • randomized controlled study • spirometry

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				S. Schuh, P. T. Dick, D. Stephens, M. Hartley, S. Khaikin, L. Rodrigues, and A. L. Coates High-Dose Inhaled Fluticasone Does Not Replace Oral Prednisolone in Children With Mild to Moderate Acute Asthma Pediatrics, August 1, 2006; 118(2): 644 - 650. [Abstract] [Full Text] [PDF]

				M. L. Edmonds, B. H. Rowe, A. K. Nakanishi, and B. Rubin Treatment With Inhaled Flunisolide Chest, May 1, 2004; 125(5): 1961 - 1963. [Full Text] [PDF]