85 Ming-Yung Lee, et al. J Med Sci 2004;24(2):85-90 http://jms.ndmctsgh.edu.tw/2402085.pdf Copyright © 2004 JMS Received: August 25, 2003; Revised: November 5, 2003; Accepted: November 10, 2003. * Corresponding author: Chih-Hsing Hung, Department of Pediatrics, Tri-Service General Hospital, 325, Cheng-Kung Road Section 2, Taipei 114, Taiwan, Republic of China. Tel: +886-2-87927025; Fax: +886-2-87927293. Comparative Efficacy of Nebulized Budesonide to Intravenous Betamethasone Treatment for Acute Childhood Asthma Ming-Yung Lee 1 , Yi-Giien Tsai 1 , Chun-Jung Chen 1 , Kuender D. Yang 2 , Der-Ming Chu 1 , Shin-Nan Cheng 1 , and Chih-Hsing Hung 1* 1 Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, 2 Chang Gung Children’s Hospital, Chang Gung University, Kaohsiung, Taiwan, Republic of China Background: This study was conducted to compare the anti-inflammatory effect of a single dose of nebulized budesonide to that of an equal dose of intravenous betamethasone in children with acute asthma. Methods: A total of 22 children with asthma, 11 patients in each group were recruited. The children were randomly assigned to: 1) a budesonide (terbutaline and budesonide) group or 2) a betamethasone (terbutaline and betamethasone) group. The pulmonary index score (PIS), peak expiratory flow rate (PEFR), exhaled nitric oxide (eNO) level, and blood pressure of all participants were evaluated before and 1, 3, 6, 7, and 12 hours after treatment. Exhaled nitric oxide (eNO) was used as a marker reflecting airway inflammation. Results: Both nebulized budesonide and intravenous betamethasone effectively decreased eNO 6 and 7 hours, respectively, after treatment. In combination with the nebulized terbutaline for avoiding early hypoxemia and distress, both nebulized and intravenous steroid increased the peak expiratory flow rate (PEFR) and decreased pulmonary index score (PIS) during the whole study period. Conclusions: Results from this study suggest that steroids such as budesonide may provide an equal anti- airway inflammation effect but fewer side effects than the intravenous betamethasone therapy in children with acute asthma. Key words: asthma, betamethasone, budesonide, exhaled nitric oxide INTRODUCTION Asthma is characterized as a chronic inflammatory process and its exacerbation is thought to be worsening of airway inflammation 1 . Evidence suggests the exhaled ni- tric oxide (eNO) levels are elevated during acute exacerba- tions of asthma. Early administration of corticosteroids in patients with acute asthma can decrease asthma attacks and reduce the hospitalization rate 1-3 . Administration of oral or parenteral corticosteroids is well known to decrease eNO levels. Thus, eNO analysis may be a sensitive, noninvasive indicator for assessing the response to anti-inflammatory therapy in children with asthma 4-6 . We have recently shown that a single dose of nebulized corticosteroid could effec- tively decrease eNO concentrations 5 . In this study, we compared the efficacy of a single dose of nebulized budesonide to that of intravenous steroid. The use of intravenous steroid early in treatment of asthmatic exacerbation reduces admissions of adults and children 7 . It has been suggested that intravenous corticosteroid be given early in the treatment of patients with acute asthma, who initially fail to respond adequately to bronchodilator therapy 8 . Godfrey et al. 9 in 1987 first reported the effect of nebulized budesonide in an infant with severe, steroid- dependent asthma. After that, many reports have demon- strated the value of budesonide therapy to young children with asthma. It is of clinical importance to determine whether nebulized steroid could replace intravenous ste- roid to reduce airway inflammation. We compared the clinical effects of a single dose of nebulized budsonide with that of a single dose of intravenous betamethasone on pulmonary index score (PIS) 2 , peak expiratory flow rate (PEFR), and changes of airway inflammation as demon- strated by eNO levels in children with acute asthma. MATERIALS AND METHODS Patients Children with asthma between the age of 6 and 17 years attending our emergency department were enrolled in this study. Before enrollment, informed consent was obtained