PURLs
Think twice about nebulizers for asthma attacks
MDIs with spacers are as effective as nebulizers for delivering beta-agonists and less likely to cause adverse effects.
EVIDENCE-BASED ANSWER:
No. Inhaled corticosteroids (ICS) don’t improve postviral cough in adults with subacute (3-8 weeks) or chronic (>8 weeks) cough, adolescents with a history of asthma but without recent asthma activity, or children with a history of episodic viral wheezing without asthma (strength of recommendation [SOR]: B, preponderance of small randomized controlled trials [RCTs]).
EVIDENCE SUMMARY
A systematic review of 7 RCTs with a total of 477 adults that examined the efficacy of ICS compared with placebo for treating subacute (3-8 weeks) and chronic (>8 weeks) cough found inconsistent, but mostly negative results.1 Most trials combined patients with nonspecific subacute and chronic cough.
The evaluated steroids included beclomethasone, budesonide, fluticasone, and mometasone; daily “budesonide equivalent” doses ranged from 320 mcg to 1600 mcg. Six of the 7 trials found that ICS didn’t improve cough. The seventh didn’t treat patients with postviral cough. The authors of the review couldn’t pool data because of heterogeneity.
Steroids don’t affect methacholine challenge in teens
A double-blind, placebo-controlled RCT of 56 adolescents found that giving ICS after viral upper respiratory infection didn’t change the methacholine dosing necessary to produce a 20% reduction in the forced expiratory volume in one second (FEV1).2 Investigators included patients if they had a previous diagnosis of asthma but no use of asthma medications in 2 years, a baseline FEV1 greater than 70% of predicted, and a concentration of methacholine that produced a 20% fall in FEV1 less than 8 mg/mL.
They randomized patients to inhaled budesonide (2 200-mcg puffs bid) or placebo (2 500-mcg puffs micronized lactose bid). Patients underwent spirometry and methacholine challenge testing every 3 months over a 9-month period. The groups didn’t differ in bronchial hyperresponsiveness or FEV1.