Efficacy of inhaled budesonide for the treatment of severe equine asthma.
Authors: Lavoie J P, Leclere M, Rodrigues N, Lemos K R, Bourzac C, Lefebvre-Lavoie J, Beauchamp G, Albrecht B
Journal: Equine veterinary journal
Summary
# Inhaled Budesonide for Severe Equine Asthma Severe equine asthma demands potent corticosteroid therapy, yet systemic administration carries significant adverse effects that limit long-term use; inhaled delivery offers a compelling alternative by targeting the airways directly whilst minimising systemic exposure. Researchers compared inhaled budesonide (administered via a novel Respimat®-based device) against intravenous dexamethasone and oral dexamethasone across two crossover studies, measuring lung function, bronchoalveolar fluid cytology, and endocrine markers including serum cortisol and ACTH. Both studies demonstrated marked, dose-dependent improvements in lung function with budesonide across all tested doses (450–1800 µg), with the higher dosages (900 and 1800 µg) producing effects comparable to systemic dexamethasone; neutrophil percentages in bronchoalveolar fluid decreased significantly with dexamethasone and in four of six horses receiving budesonide. Notably, higher budesonide doses and dexamethasone treatments both suppressed serum cortisol concentrations, suggesting inhaled budesonide achieves systemic corticosteroid effects despite local delivery. Whilst these findings support inhaled budesonide as an effective severe asthma treatment with potential advantages for long-term management, the Respimat® device remains unavailable commercially, limiting immediate clinical application—practitioners should monitor developments in inhaled corticosteroid availability and remain alert to endocrine effects even with targeted airway delivery.
Read the full abstract on PubMed
Practical Takeaways
- •Inhaled budesonide delivered via Respimat device offers effective airway obstruction relief in severe equine asthma with reduced systemic side effects compared to systemic corticosteroids
- •The dose-dependent response indicates clinical flexibility, with higher doses providing effects equivalent to traditional oral/IV dexamethasone therapy
- •Cortisol suppression still occurs with inhaled budesonide, suggesting need for monitoring despite local delivery reducing overall systemic burden
Key Findings
- •Inhaled budesonide at 1800 μg twice daily produced marked and significant improvement in lung function comparable to intravenous dexamethasone
- •Budesonide showed dose-dependent effects with 450, 900, and 1800 μg doses, with higher dosages comparable to oral dexamethasone efficacy
- •Neutrophil percentages in bronchoalveolar fluid decreased in all dexamethasone-treated horses and 4 of 6 budesonide-treated horses
- •Both budesonide and dexamethasone induced significant suppression of serum cortisol concentrations