Emergency Department (ED) Use of Nebulized Budesonide as an Adjunct to Standardized Therapy in Acutely Ill Adults With Refractory Asthma: a Randomized, Double-blinded, Placebo-controlled Trial
Overview
- Phase
- Phase 3
- Intervention
- Budesonide
- Conditions
- Asthma
- Sponsor
- Northwell Health
- Enrollment
- 95
- Locations
- 3
- Primary Endpoint
- FEV1 Percent Predicted
- Status
- Completed
- Last Updated
- 10 years ago
Overview
Brief Summary
To determine whether adding nebulized inhaled steroids to the standard care of acutely ill ED patients with refractory acute asthma helps improve forced expiratory volume at one second (FEV1) and decrease the need for hospitalization.
Detailed Description
This is a randomized clinical trial studying the effect of nebulized budesonide (Pulmicort) in acutely ill adults presenting to the Emergency Department with severe asthma. Budesonide is an inhaled steroid FDA approved for the treatment of pediatric chronic asthma. ED entry criteria include hyporesponsiveness to nebulized beta-agonists and an FEV1\<50% predicted. The trial will evaluate the efficacy of multiple doses of nebulized budesonide as an adjunct to a highly regimented standardized treatment protocol; standard care consists of bronchodilators (beta-agonists/anticholinergics), systemic steroids, and intravenous magnesium sulfate (if the FEV1\<25% predicted). The primary efficacy endpoint will be the FEV1 4 hours after administration of the study intervention. An additional safety and efficacy endpoint will take place at 5 hours after study intervention. The treatments will be coupled with a protocol-defined assessment regimen, with endpoints measured before each treatment and on ED disposition (at 5 hours after study intervention).
Investigators
Robert A Silverman
Physician
Northwell Health
Eligibility Criteria
Inclusion Criteria
- •FEV1\<50% predicted after bronchodilator therapy, age 18-60, presenting to an emergency department with acute asthma
Exclusion Criteria
- •other chronic lung disease, \>15 pack years smoking
Arms & Interventions
B
Budesonide, 2mg, 4 doses, plus standard care
Intervention: Budesonide
B
Budesonide, 2mg, 4 doses, plus standard care
Intervention: albuterol
B
Budesonide, 2mg, 4 doses, plus standard care
Intervention: Ipratropium bromide
B
Budesonide, 2mg, 4 doses, plus standard care
Intervention: Prednisone
P
Placebo plus standard care
Intervention: albuterol
P
Placebo plus standard care
Intervention: Ipratropium bromide
P
Placebo plus standard care
Intervention: Prednisone
Outcomes
Primary Outcomes
FEV1 Percent Predicted
Time Frame: 4 hours post-randomization
Secondary Outcomes
- Hospitalization(6 hours)