Effect of Nebulized Corticosteroids on Lung Function in Patients with Chronic Asthma

Abstract

Patients with chronic asthma, who failed treatment with prolonged use of corticosteroids (metered dose inhalers, oral and/or parenteral), nebulized bronchodilators, and mast cell stabilizers (cromolyn sodium), all with severe signs and symptoms of reactive airway disease, were evaluated over the course of 6 months and subjected to spirometries at initial presentation, later when anti-inflammatory agents, bronchodilators, and corticosteroids were added, and finally when nebulized triamcinolone acetonide (TAA) was started. TAA was diluted in a concentration of 1 mg/ml, and given via nebulizer repeatedly from two to four times a day, taking in consideration the patient's age and weight and the severity of the symptoms. All the patients evaluated aged 5-24 years of age demonstrated a maximum midexpiratory flow rate (MMEFR) of 50% or less of predicted values on initial presentation. After the start of corticosteroids, bronchodilators or cromolyn sodium, the mean improvement on the forced vital capacity (FVC) was 16%, FEV₁ improved 23%, and the MMEFR improved 39%. After the introduction of nebulized TAA, the mean improvement in pulmonary function tests was 69% in the FVC, 90% in the FEV₁, and 142% in the MMEFR when compared with initial values. The overall outcome of the study showed a very marked improvement of symptoms and pulmonary function tests after the patients were treated with nebulized TAA in addition to their conventional treatment, with consequent reduction in the amount of drugs needed to maintain control of the symptoms. It is important to mention that compliance with the treatment and lack of side effects was guaranteed and well controlled.