Background: Acute severe asthma exacerbations remains a treatment challenge. The value of inhaled added to systemic corticosteroids in the treatment of acute severe asthma is not well addressed.
The Aim of the Work: This study aimed to investigate the value of inhaled corticosteroids added to systemic corticosteroids compared to systemic corticosteroids alone in the management of acute severe asthma exacerbation treated in emergency room..
Patients and Methods: 115 patients were included and divided into study (n = 55) included patients received inhaled hydrocortisone 100 mg IV, nebulized ipratropium bromide 500µg , Salbutamol 0.5 % respiratory solution and budesonide 0.5 mg at 20-, 40-, 60- and 120-min; and the comparison (n= 60) group received the standard protocol only.  The following data were documented: Respiratory rate, heart rate, blood pressure, peak expiratory flow rate, were documented over 3 hours after initiation of treatment. The Primary outcome was improvement of PEF and the admission rate. 
Results: The basal PEF (L/min) ranged between 120 and 210, with no significant differences. There was progressive reduction of PEF overtime in both groups. However, the percentage of reduction was significantly higher in the study than the comparison groups (99.86±16.64 vs  89.52±22.25, respectively). The difference between groups was significant at 120 to 180 minutes. Respiratory rate was significantly and progressively reduced in both the study and the comparison groups at the end of assessment than the basal values. The percentage of reduction was significantly higher among the study than the comparison groups (38.22±4.20 vs 36.21±4.14, respectively, p = 0.011). The study and comparison groups showed non-significant differences, as hospitalization was recorded for 29.1% and 35.0% of the study and the comparison groups respectively.
Conclusion: The association of nebulized budesonide with systemic corticosteroids provides mild additional effects than systemic corticosteroids alone for severe asthma in emergency department.