***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: UNLABELLED Recovery from an asthma exacerbation may take days or weeks even after the introduction of appropriate exacerbation therapy . However airway responsiveness and sputum eosinophils can be reduced within 6 hours by a single dose of inhaled corticosteroids . AIM To determine if a single dose of 3200 microg of budesonide increases the rate of recovery from an asthma exacerbation . METHODS Nineteen asthmatic subjects with an asthma exacerbation following withdrawal of inhaled corticosteroids were r and omised to receive either usual care ( doubling their dose of inhaled corticosteroids ) plus placebo or usual care plus a single dose of 3200 microg of budesonide in a double-blind manner . Subjects monitored peak flow ( PEF ) , symptoms , and beta agonist use daily for four weeks . The lowest PEF reading for each week was calculated as a percentage of the best peak flow value achieved in the recent past ( PEF lowest % best ) . RESULTS In the first week following exacerbation , PEF ( lowest % best ) was significantly greater in the budesonide group than in the placebo group ( 87.4 + /- 4.7 vs. 76.7 + /- 5.3 ; p = 0.029 ) . However in the fourth week following exacerbation PEF was not significantly different ( p = 0.728 ) . The proportion of subjects who had a symptom free day during the first week was significantly higher in the budesonide group ( p = 0.0012 ) . CONCLUSION A single high dose of inhaled corticosteroids added to usual exacerbation treatment might increase the rate of recovery from a mild exacerbation of asthma The study was undertaken to examine the clinical effectiveness of nebulizer inhalations of budesonide suspension during severe attacks of bronchial asthma ( BA ) and the possibility of its use versus systemic glucocorticosteroids ( GCSs ) .  Sixty-eight patients admitted for a severe attack of BA were examined . The forced expiratory volume per sec ( FEV1 ) was less than 40 % and the peak forced expiration rate ( PFER ) was less than 150 l/min . First-line therapy included inhaled salbutamol ( 5 - 10 mg within 1.5 - 2 hours ) , oxygen , and intravenous prednisolone ( 120 mg ) . Thirty-two patients showed a good response to first-line therapy ( a more than 50 % increase in FEV1 ) as compared with the normal values ) ( Group 1 ) and 36 patients with concurrent obstructive lung disease ( COLD ) had an inadequate response ( FEV1 was less than 40 % of the normal values ) was found in 32 patients ( Group 2 ) . Then the patients were r and omized : 16 patients from Group 1 took budesonide , 4 mg/day , the other 16 received intravenous prednisolone , 120 mg/day . In Group 2 , the efficacy of the drug added to therapy with oral prednisolone , 30 mg/day , was evaluated : 18 patients were given budesonide , 4 mg/day , and 18 received placebo . In patients with a good response to primary therapy , positive clinical and functional changes were found on day 6 of treatment . Group 2 patients receiving budesonide showed a significantly ( p < 0.05 ) more marked positive changes in BA symptoms , FEV1 , and PFER , which allowed a course of therapy with systemic GCSs to be reduced . Nebulized budesonide may be used instead of systemic GCSs to treat exacerbated BA if there is a good clinical and functional response to first-line broncholytic therapy , which is indicative of successful abatement of bronchospasm . If there is a poor response to first-line therapy in patients with more severe BA concurrent COLD , the early use of budesonide suspension in addition to systemic GCSs may enhance the efficiency of therapy for BA attacks and reduce the volume of systemic steroidal therapy The aim of the present study was to investigate the efficacy and safety of nebulized fluticasone propionate ( FP Nebules ) compared with oral soluble prednisolone in children with an acute exacerbation of asthma . The study used an international , multi-centre , r and omized , double-blind , parallel group design . Three hundred and twenty-one patients , aged 4 - 16 years old , who presented with an acute exacerbation of asthma , were r and omly allocated to either nebulized FP ( 1 mg b.d . ) or oral prednisolone ( 2 mg kg(-1 ) day(-1 ) for 4 days then 1 mg kg(-1 ) day(-1 ) for 3 days ) for 7 days . Patients in the FP group showed a significantly greater increase in diary card morning peak expiratory flow ( PEF ) over 7 days compared with patients in the prednisolone group ( difference = 9.51 min(-1 ) , CI = 2.1 , 16.8 , P = 0.034 ) . Similar increases for both treatments were shown for evening PEF . Clinic PEF improved with both treatments , but was significantly greater in patients taking FP after 7 days ( difference = 11.41 min(-1 ) , CI = 2.8 , 20.0 , P = 0.029 ) . Both treatments reduced symptom scores to a similar extent . The two treatments were well tolerated , and there was no difference in the incidence of adverse events . The present study demonstrated that nebulized FP is at least as effective as oral prednisolone in the treatment of children presenting with an acute exacerbation of asthma Background : The role of inhaled corticosteroids in the treatment of acute asthma remains a controversial subject . Objective and methods : A r and omized , double‐blind , placebo‐controlled parallel‐group clinical trial on the effect of a 5‐d course of nebulized budesonide treatment in children with mild to moderate exacerbation of asthma was performed . The need for systemic corticosteroid intervention was evaluated as the primary outcome measure . Results : Sixty‐seven children aged 6 to 15 y were enrolled . During the emergency department phase , they received three nebulizations of either budesonide(1 mg/dose ) or placebo , and then in the home phase of the study , they continued their study medications twice a day for another 4 d. Though the level of improvement in the emergency department phase was similar between the groups given either budesonide or placebo treatments ( 6.8±1.9 % vs 4.0±1.5 % , p=0.30 , respectively ) , nebulized budesonide caused a trend towards a benefit in terms of the need for systemic corticosteroid intervention ( 2/33 vs 7/34 , p=0.07 ) , but not in secondary outcome measures STUDY OBJECTIVE To determine the effect of early administration of high-dose intravenous corticosteroids on duration of emergency room treatment and hospital admission rate in patients with acute asthma . DESIGN R and omized , double-blind , placebo-controlled trial . SETTING The emergency room of a large , urban hospital with primary and referral care responsibilities . PATIENTS Eighty-one patients from 18 to 45 years of age with acute bronchial asthma and without pneumonitis or other serious underlying illnesses were studied on 91 occasions and were r and omly assigned to control or experimental groups . INTERVENTIONS The steroid group received 125 mg of intravenous methylprednisolone whereas the control group received intravenous normal saline 30 minutes after initial treatment . Additional treatment included aerosolized metaproterenol and oral theophylline therapy . Six hours after study entry , remaining patients were treated with 40 mg of intravenous methylprednisolone . Hospitalization was m and atory if total treatment time was greater than 12 hours . MEASUREMENTS AND MAIN RESULTS Age , sex , peak expiratory flow at entry , and prevalence of recent corticosteroids use were similar in both groups . Duration of emergency room treatment was 6.7 + /- 4.2 ( SD ) hours in the steroid group and 6.3 + /- 4.1 hours in the control group ( P = 0.66 ) . Hospitalization was necessary in 18 % ( 95 % CI , 7 % to 30 % ) of the steroid group and in 13 % ( CI , 3 % to 22 % ) of the control group . Frequency of return visits for acute asthma 2 days after emergency room discharge was 11 % ( CI , -1 % to 22 % ) in the steroid group and 13 % ( CI , 2 % to 23 % ) in the control group . CONCLUSIONS These results fail to show any benefit for early administration of corticosteroids in patients with acute asthma . Routine administration of corticosteroids on initial presentation in such patients may not be warranted Objective : Acute severe exacerbation of asthma is potentially life threatening and requires critical assessment and appropriate therapy . Now a days , steroids are often combined with bronchodilators for the treatment of bronchial asthma . Therefore , the present study was undertaken to compare effectiveness of beclomethasone diproprionate-salbutamol combination versus salbutamol alone by MDI ( with or without spacer ) in acute asthma . Methods : A total of 57 paediatric patients ( 5–12 years ) with acute attack of bronchial asthma attending emergency department of Indira G and hi Medical College and Hospital was r and omised to receive salbutamol ( 100 μg/puff ) alone or with BDP ( 50 μg/puff ) by metered dose inhaler with or without spacer . All baseline investigations were repeated one hour after the therapy . Results : Clinical parameters indicative of severity of asthma improved statistically in all treatment groups . The increase in PEFR was better with MDI-S+B with spacer as compared to other groups , though it failed to reach statistical significance . The fall in serum potassium level is significantly more with MDI-S+B group when spacer was not used . No serious adverse effects were observed in any of the treatment groups . Conclusions . Metered dose inhalation of BDP-salbutamol combination with spacer provides better recovery whereas fall in serum potassium with MDI-S+B suggests use of spacer and monitoring of serum potassium during treatment This study was conducted to investigate whether a single dose of nebulized budesonide effectively decreased  airway inflammation  as demonstrated by exhaled nitric oxide ( eNO ) levels . A single dose of nebulized budesonide , but not nebulized terbutaline , rapidly decreased eNO levels in 6 hours . The decrease in eNO levels induced by nebulized budesonide was correlated to an increase in peak expiratory flow rate BACKGROUND Anticholinergic medications such as ipratropium improve the pulmonary function of patients with acute exacerbations of asthma , but their effect on hospitalization rates is uncertain . METHODS We conducted a r and omized , double-blind , placebo-controlled study of 434 children ( 2 to 18 years old ) who had acute exacerbations of moderate or severe asthma treated in the emergency department . All the children received a nebulized solution of albuterol ( 2.5 or 5 mg per dose , depending on body weight ) every 20 minutes for three doses and then as needed . A corticosteroid ( 2 mg of prednisone or prednisolone per kilogram of body weight ) was given orally with the second dose of albuterol . Children in the treatment group received 500 microg ( 2.5 ml ) of ipratropium bromide with the second and third doses of albuterol ; children in the control group received 2.5 ml of normal saline at these times . RESULTS Overall , the rate of hospitalization was lower in the ipratropium group ( 59 of 215 children [ 27.4 percent ] ) than in the control group ( 80 of 219 [ 36.5 percent ] , P=0.05 ) . For patients with moderate asthma ( indicated by a peak expiratory flow rate of 50 to 70 percent of the predicted value or an asthma score of 8 to 11 on a 15-point scale ) , hospitalization rates were similar in the two groups ( ipratropium : 8 of 79 children [ 10.1 percent ] ; control : 9 of 84 [ 10.7 percent ] ) . For patients with severe asthma ( defined as a peak expiratory flow rate of < 50 percent of the predicted value or an asthma score of 12 to 15 ) , the addition of ipratropium significantly reduced the need for hospitalization ( 51 of 136 children [ 37.5 percent ] , as compared with 71 of 135 [ 52.6 percent ] in the control group ; P=0.02 ) . CONCLUSIONS Among children with a severe exacerbation of asthma , the addition of ipratropium bromide to albuterol and corticosteroid therapy significantly decreases the hospitalization rate The use of steroids in treating acute respiratory obstruction is still controversial . In this double-blind controlled trial , we decided to examine the beneficial effects of a single large dose of methylprednisolone ( MSSP ) , using objective criteria . In the emergency setting , methylprednisolone ( 30 mg/kg ) has been shown to decrease the need for hospital admission in patients with acute bronchospasm . No difference in this improvement was seen among patients in the steroid-dependent or non-steroid-dependent population s. Based on 
    Output:
    
REVIEW ER 'S CONCLUSIONS Inhaled steroids reduced admission rates in patients with acute asthma , but it is unclear if there is a benefit of inhaled corticosteroids when used in addition to systemic corticosteroids .
There is insufficient evidence that inhaled corticosteroids result in clinical ly important changes in pulmonary function or clinical scores when used in acute asthma .
Similarly , there is insufficient evidence that inhaled corticosteroids alone are as effective as systemic steroids .