Efficacy and safety of inhalation budesonide in the treatment of pediatric asthma in the emergency department: a systematic review and meta-analysis

Background: This study was aimed to evaluate the beneficial role of inhalation budesonide(BUD) in improving the pulmonary functions, and reducing the hospital admission rate, worsening of asthma and commonly encountered adverse events in pediatric asthma. Methods: The electronic search was performed using PubMed, Scopus, CENTRAL (Cochrane Central Register of Controlled Trials) and Google scholar databases to identify the randomized control trials(RCTs). Results: 21 RCTs involving 12,787 subjects were included. The meta-analysis revealed that the BUD has reduced the hospitalization rate (Mantel–Haenszel (M–H), random effects odd ratio (RE-OR) of 0.34, p = 0.003, I² = 75%), and worsening of asthma (M–H, RE-OR 0.38, p = 0.001, I² = 73%); significantly improved the pulmonary functions such as FEV1 (Inverse variance (IV): 1.05, p < 0.0001, I² = 94%), PEFR (IV: 1.40, p < 0.0001, I² = 87%), morning PEF (IV: 1.04, p < 0.0001, I² = 91%), and evening PEF (IV: 1.29, p < 0.0001, I² = 92%) compared to control. Further, the incidences of adverse events like Pharyngitis (M–H, RE-OR 0.88, at 95% CI, p = 0.69, I² = 0%), Sinusitis (M–H, RE-OR 0.78, p = 0.79, I² = 0%), Respiratory infections (M–H, RE-OR 0.96, p = 0.46, I² = 0%), Otitis media (M–H, RE-OR 0.82, p = 0.32, I² = 12%) and Fever (M–H, RE-OR 0.78, p = 0.64, I² = 0%) were almost same between BUD and control. Conclusion: The outcomes of the meta-analysis suggest that high-dose inhalation BUD could benefit the pediatric patients in minimizing the worsening of asthma and hospitalization rate, along with improving the pulmonary functions, with negligible adverse drug reactions. Graphic abstract: [Figure not available: see fulltext.].