Clinical observations of nebulized flunisolide in infants and young children with asthma and bronchopulmonary dysplasia

Abstract

Severe bronchopulmonary dysplasia (BPD) is frequently associated with asthma. The combination is often severe enough to necessitate corticosteroid therapy. There are no commercially available nebulizer solutions of corticosteroids for use in infants and young children. Seven infants and small children with very severe BPD and asthma aged 6-24 months, were treated with flunisolide, 187-250 micrograms q.i.d. in the form of nasal spray delivered by nebulizer. After treatment for 2.5-20 months, four patients showed clinical improvement, one initially improved but later deteriorated and died of cardiac failure, and two patients showed no improvement and died within 3 months. The number of days of hospitalization was significantly reduced from 8.4/month to 2.5/month (P less than 0.05). No side-effects were detected and it was felt that the three patients who died, did so as a consequence of very severe BPD and its cardiac consequences. The suspension remained stable for 80 min when mixed with normal saline, cromolyn sodium, albuterol, or acetylcysteine. It is concluded that nebulized flunisolide is a potentially useful treatment for infants and young children with asthma and BPD.

A Randomized Trial of Inhaled Versus Intravenous Steroids in Ventilator-Dependent Preterm Infants

“…3,4 However, our study did not support this conclusion. The incidence of culture proven sepsis, hypertension, or hyperglycemia, commonly reported with the use of intravenous steroids, was similar between the three groups.…”

“…1,2 The inhaled route of delivery of steroids may maximize pulmonary effects while minimizing systemic effects as documented by the clinical success in delivering steroids through metered-dose inhalation to young asthmatic patients. 3,4 Initial studies examining inhaled steroids for the treatment of BPD in ventilator-dependent VLBW infants utilized both nebulized and metered-dose inhaled steroids, which appeared to be of some benefit for these infants. 5 -8 Delivery of inhaled steroids through a metered-dose inhaler system was demonstrated to be more efficient in two different laboratory models by O'Callaghan et al 9 and Rozycki et al 10 Because the number of studies done with inhaled steroids is small, the benefits and possible adverse effects of inhaled steroids used for the treatment of BPD in ventilator-dependent VLBW infants are not well known.…”

Gastroesophageal reflux in infants with wheezing

“…It is known that there is no loss of potency after 80 min when flunisolide is mixed with other nebulized asthma medications. 23 In other studies, doses up to 250 mcg every 6 hr have been used with variable success in infants. 20,21,23 Although no significant side effects are reported thus far, the safety of nasal corticosteroid solutions in nebulized form is not fully established.…”

“…18 Optimal doses of nebulized steroid suspen- 20 Since no nebulized form of glucocorticoids is available in the United States, we used an intranasal flunisolide preparation by nebulizer because other groups had found it to be a useful and safe treatment for infants with asthma. [21][22][23] Many infants with daily wheezing may not have symptoms of GER such as regurgitation, feeding difficulties, and irritability. We undertook this study to confirm the prevalence of silent GER in infants with difficult-tocontrol, daily wheezing who were otherwise healthy, and to evaluate the difference in the outcome of infants with GER from those without GER.…”

Critical analysis of the use of corticosteroids in the neonatal period

“…LaForce e Brudno administraram beclometasona 50 ug/dia durante 2 semanas 51 . Pokriefka utilizou flunisolida durante 28 dias e Konig (1992), 187-250 ug/dia de flunisolida 52 .…”