The relationship of additional nebulized steroids to standard treatment with hospital admission rates in patients with moderate acute asthma exacerbation at the emergency department (a tertiary hospital in Bangkok)
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Abstract
Objective : To compare the differences in the efficacy of nebulized budesonide in combination with standard treatment versus standard treatment alone on hospital admission rates in patients with moderate acute asthma exacerbation in the emergency department.
Materials and Methods : This retrospective cohort study reviewed medical records of 106 patients with moderate acute asthma exacerbation treated at the emergency room of Ratchapipat Hospital from January 2021 to July 2023. Patients were divided into the standard treatment group (n = 53) and the adjunctive nebulized budesonide group (n = 53). Primary outcome was hospitalization rate. Secondary outcomes included length of hospital stay, oxygen saturation, revisit rate, and adverse events. Chi-square test and multiple regression analysis were used for data analysis.
Results : The hospitalization rates between the two groups did not show a statistically significant difference. However, the budesonide group tended to have a lower rate compared to the standard treatment group (24.5% vs 35.8%; p = 0.204). The length of hospital stay did not show a statistically significant difference. (2.9 ± 1.1 days vs 3.3 ± 2.0 days, p = 0.384). The oxygen saturation after nebulization in the budesonide group was significantly higher than the control group (98.0 ± 1.4% vs 96.6 ± 3.1%, p = 0.006). No significant differences were found in revisit rates (p = 1.000) and adverse effects (p = 1.000).
Conclusion : The addition of nebulized budesonide 1.5 mg did not significantly reduce hospitalization rates, length of hospital stay, or revisit rates in patients with moderate acute asthma exacerbations treated in the emergency department. Further large-scale randomized controlled trials with high-dose budesonide should be conducted to confirm the results of this study.
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