The object of this study was to determine whether high doses of inhaled budesonide provide additional benefits to a standardized treatment regimen that includes systemic steroids and salbutamol in preschool patients presented to the emergency department (ED) with acute wheezing attacks. Methods This randomized, double-blind, placebo-controlled, parallel group trial was conducted in children, 6 months-6 years with moderate or severe acute wheezing epizode, as determined based on a pulmonary index score (PIS) of 7-13 points. We compared the addition of budesonide 3 mg versus placebo to standard acute asthma treatment, which included salbutamol and a single 1 mg/kg dose of methylprednisolone given at the beginning of therapy. The primary outcome was differences in hospitalization rates within 4 hr. Secondary outcome was difference in median PIS between treatment groups at 2 hr. Results One hundred patients were enrolled. Cumulative hospitalization rate at 120, 180, and 240 min were 0.72, 0.62, and 0.58 in placebo group; and 0.44, 0.30, and 0.24 in budesonide group. Discharged rate in budesonide group was significantly higher than the placebo group (log-rank = 12.407 ve P < 0.001). Expected mean discharged times were 200.4 (95%CI = 185.3-215.5) min in placebo group and 164.4 (95%CI = 149.4-179.4) min in budesonide group. Median (25-75%) PIS at the 120th min was significantly lower in budesonide group than the placebo group (5 [4-8] vs. 8 [5-9] respectively, P = 0.006). Conclusions The addition of budesonide nebulization may decrease the admission rate of preschool children who have moderate to severe acute wheezing epizodes. Pediatr Pulmonol. 2017;52:720-728. © 2017 Wiley Periodicals, Inc.

Özet ABS tRACtAim: Only epinephrine should be administered to treat anaphylaxis and patients should be prescribed epinephrine auto-injectors on discharge. This questionnaire study was designed to determine the awareness of physicians and other healthcare providers concerning anaphylaxis and the use of epinephrine auto-injectors at a tertiary child care hospital. Materials and Methods:The study was carried out between February 1 st and March 15 th , 2014 at Dr. Sami Ulus Maternity and Children's Research and Training Hospital, a tertiary care hospital. A total of 166 healthcare providers, including physicians and other staff such as nurses and paramedics, participated in the study. The demographic characteristics, experience in treating anaphylaxis and epinephrine auto-injector training were obtained using a standardized questionnaire. The obtained data were statistically analyzed. Results:The participants were composed of specialist doctors (25.9%), pediatric residents (31.9%) and other healthcare staff (42.2%). Eighty-four (50.6%) of the participants were found to have received training on anaphylaxis. Among the trained healthcare providers, 62 (73.8%) informed us that epinephrine by intramuscular route was applied during anaphylaxis. On the other hand, only 32 (39%) of untrained healthcare providers had chosen the intramuscular administration of epinephrine (p=0.00). 27.8% of those who had not received anaphylaxis training knew about it, while 64.8% of the healthcare providers who had received anaphylaxis training knew about adrenaline autoinjector. Only 5 of those who knew about the adrenaline auto-injector (5.3%) had prescribed the adrenaline report. While 81 (48.8%) of the participitants had some knowledge about the epinephrine auto-injector, only two specialists and three pediatric residents (3%) were found to prescribe the epinephrine auto-injector. Conclusion: Post-graduate training is required for the treatment of anaphylaxis. All healthcare providers should be trained on the use of epinephrine and prescribing epinephrine auto-injector.

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