High dose nebulized steroid in the treatment of chronic steroid-dependent asthma

Respir Med. 1992 Mar;86(2):105-8. doi: 10.1016/s0954-6111(06)80224-6.


Despite the dramatic success of inhaled steroids in controlling asthma symptoms there remains a small number of patients in whom asthma can only be treated with continuous oral steroids. Eighteen such patients, aged 19-62 years (seven males, 11 females) were followed in an open trial of nebulized budesonide over 12-18 months. All had required at least 7.5 mg or more daily prednisolone to control their symptoms over the preceeding 2 or more years and were taking 1200 micrograms beclomethasone dipropionate or 1600 micrograms budesonide daily. With a daily dose ranging between 4 and 8 mg nebulized budesonide, 14 patients successfully stopped oral steroids while in three the dose was reduced; only one patient failed to benefit. There was an increase in the mean FEV1 from 1.9 (+/- 0.9) to 2.2 (+/- 0.9) l, and in the mean morning PEFR, from 238 (+/- 119) to 286 (+/- 130) l min-1. There was also a significant decrease in the mean number of hospital admissions for acute severe asthma, from 1.5 (+/- 1.8) to 0.9 (+/- 1.1) per year. These findings should encourage a careful and controlled evaluation of nebulized steroids as a substitute for oral steroids in this difficult group of asthmatics.

MeSH terms

  • Adult
  • Asthma / drug therapy*
  • Asthma / physiopathology
  • Budesonide
  • Chronic Disease
  • Female
  • Forced Expiratory Volume / physiology
  • Humans
  • Male
  • Middle Aged
  • Nebulizers and Vaporizers
  • Peak Expiratory Flow Rate / physiology
  • Prednisolone / therapeutic use
  • Pregnenediones / administration & dosage
  • Pregnenediones / therapeutic use*
  • Vital Capacity / physiology


  • Pregnenediones
  • Budesonide
  • Prednisolone