Effectivness of Nebulized Budesonide for COPD Exacerbation Management in Emergency Department; a Randomized Clinical Trial

Nebulized budesonide has been long used in chronic obstructive pulmonary disease (COPD)exacerbation. This study aimed to compare the effectiveness of nebulized budesonide (NB) versus oral pred-nisolone (OP) in increasing peak expiratory flow rate (PEFR) of COPD patients in emergency department (ED).

Patients with COPD exacerbation, referring to ED were enrolled in this randomized trial study. In thefirst group, NB 0.5 mg every 30 minutes till three doses, placebo tablet, and standard treatment was adminis-tered. In the second group, nebulized normal saline, OP tablet 50 mg, and standard treatment were adminis-tered. Patients’ demographic data, vital signs, PEFR, venous blood gas (VBG) analysis, disposition, and patientand physician satisfaction were all collected and compared between the two groups.

43 patients inthe NB group and 41 patients in the OP group were evaluated. The two groups had similar age (p=0.544) andgender (p=0.984) distribution, duration of illness (p=0.458), and baseline PEFR (p=0.400). 12 and 24 hours aftertreatment, significant increase in PEFR in the NB and OP groups were observed (p=0.032 and 0.008; respec-tively). The upward trend of PEFR in NB group was significantly better than that of OP group during 24 hoursof treatment (p=0.005). Vital signs and VBG results showed no significant differences between the two groupsduring the studied time interval.

NB, compared to OP, could more effectively increase PEFR andameliorate disease severity of patients with COPD exacerbation at 12 and 24 hours after treatment in ED