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Open Access Journal Article

Effect of Budesonide and Systemic Corticosteroids on Hospital Admissions and Length of Stay: A Meta-analysis

by Ahmed S. Shafiey 1,*  and  Hend Ahmed 1
1
Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
*
Author to whom correspondence should be addressed.
IJCMR  2025 3(2):52; https://doi.org/10.61466/ijcmr3020002
Received: 1 January 2025 / Accepted: 19 February 2025 / Published Online: 19 February 2025
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Abstract

Background

Asthma is a common chronic illness in children, contributing significantly to healthcare costs and morbidity. Despite the use of systemic corticosteroids (SC) as the standard treatment for acute asthma, their delayed onset and incomplete efficacy in reducing hospitalization have led to interest in inhaled corticosteroids (ICS) as adjunctive therapy.

Methods

This meta-analysis aimed to evaluate the efficacy of combining budesonide (an ICS) with SC in children with acute asthma. A systematic search of databases identified 10 studies involving 1,588 children, of whom 794 received budesonide in addition to SC, while the remaining 794 received SC alone.

Results

The addition of budesonide was associated with a non-significant reduction in hospital admission rates (OR 0.48, 95% CI 0.25–0.91, p=0.02) and length of stay. Studies with higher doses of budesonide (≥2mg) showed a greater but still non-significant improvement in asthma severity scores.

Conclusions

While combining ICS and SC resulted in a potential cost-effective benefit, further trials with higher doses of budesonide are needed. Major limitations include the absence of studies involving MDI-based ICS delivery, limited data on lung function, and the lack of recent trials after 2020.

Keywords: ;
Copyright: © 2025 by Shafiey and Ahmed. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (Creative Commons Attribution 4.0 International License). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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ACS Style
Shafiey, A. S.; Ahmed, H. Effect of Budesonide and Systemic Corticosteroids on Hospital Admissions and Length of Stay: A Meta-analysis. International Journal of Clinical Medical Research, 2025, 3, 52. doi:10.61466/ijcmr3020002
AMA Style
Shafiey A S, Ahmed H. Effect of Budesonide and Systemic Corticosteroids on Hospital Admissions and Length of Stay: A Meta-analysis. International Journal of Clinical Medical Research; 2025, 3(2):52. doi:10.61466/ijcmr3020002
Chicago/Turabian Style
Shafiey, Ahmed S.; Ahmed, Hend 2025. "Effect of Budesonide and Systemic Corticosteroids on Hospital Admissions and Length of Stay: A Meta-analysis" International Journal of Clinical Medical Research 3, no.2:52. doi:10.61466/ijcmr3020002

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References

  1. Akinbami, L.J., et al., Status of childhood asthma in the United States, 1980–2007. Pediatrics, 2009. 123(Supplement_3): p. S131-S145.
  2. Asher, I. and N. Pearce, Global burden of asthma among children. The international journal of tuberculosis and lung disease, 2014. 18(11): p. 1269-1278.
  3. Lung, N.H. and B. Institute. Global initiative for asthma: global strategy for asthma management and prevention. in NHLBI/WHO workshop report. NHLBI publication. 1995.
  4. James, D.R. and M.D. Lyttle, British guideline on the management of asthma: SIGN Clinical Guideline 141, 2014. Archives of Disease in Childhood-Education and Practice, 2016. 101(6): p. 319-322.
  5. Alangari, A.A., et al., Budesonide nebulization added to systemic prednisolone in the treatment of acute asthma in children: a double-blind, randomized, controlled trial. Chest, 2014. 145(4): p. 772-778.
  6. Chen, A.h., et al., Effects of nebulized high‐dose budesonide on moderate‐to‐severe acute exacerbation of asthma in children: a randomized, double‐blind, placebo‐controlled study. Respirology, 2013. 18: p. 47-52.
  7. Edmonds, M.L., et al., Early use of inhaled corticosteroids in the emergency department treatment of acute asthma. Cochrane Database of Systematic Reviews, 2012(12).
  8. Castro-Rodriguez, J., et al., Adding nebulized to systemic corticosteroids for acute asthma in children: a meta-analysis. Authorea Preprints, 2020.
  9. DS, S., Meta-Analysis of Observational studies in Epidemiology. A proposal for reporting. J Am Med Assoc, 2000. 283: p. 2008-2012.
  10. Higgins, J.P., et al., Measuring inconsistency in meta-analyses. Bmj, 2003. 327(7414): p. 557-560.
  11. Liberati, A., et al., The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Annals of internal medicine, 2009. 151(4): p. W-65-W-94.
  12. Collaboration, C., RoB. 2: A revised Cochrane risk-of-bias tool for randomized trials. Available at (Diakses 1 Juli 2022): bias/resources/rob-2-revised-cochrane-risk-bias-tool-randomized-trials, 2020.
  13. Sung, L., M.H. Osmond, and T.P. Klassen, Randomized, controlled trial of inhaled budesonide as an adjunct to oral prednisone in acute asthma. Academic emergency medicine, 1998. 5(3): p. 209-213.
  14. Sano, F., et al., Inhaled budesonide for the treatment of acute wheezing and dyspnea in children up to 24 months old receiving intravenous hydrocortisone. Journal of allergy and clinical immunology, 2000. 105(4): p. 699-703.
  15. Nuhoglu, Y., et al., Acute effect of nebulized budesonide in asthmatic children. JOURNAL OF INVESTIGATIONAL ALLERGOLOGY AND CLINICAL IMMUNOLOGY, 2005. 15(3): p. 197.
  16. Upham, B.D., et al., Nebulized budesonide added to standard pediatric emergency department treatment of acute asthma: a randomized, double‐blind trial. Academic Emergency Medicine, 2011. 18(7): p. 665-673.
  17. Akhtaruzzaman, M., et al., Effects of nebulized budesonide as an adjunct to standard treatment of asthma exacerbations: a randomized, double-blind, placebo-controlled trial. Mymensingh Medical Journal: MMJ, 2014. 23(3): p. 418-425.
  18. Razi, C.H., et al., The addition of inhaled budesonide to standard therapy shortens the length of stay in hospital for asthmatic preschool children: a randomized, double-blind, placebo-controlled trial. International Archives of Allergy and Immunology, 2015. 166(4): p. 297-303.
  19. Razi, C.H., N. Cörüt, and N. Andıran, Budesonide reduces hospital admission rates in preschool children with acute wheezing. Pediatric Pulmonology, 2017. 52(6): p. 720-728.
  20. Kassisse, E., et al., Estudio aleatorizado abierto de niños con exacerbación aguda del asma tratados con esteroides inhalados. Revista Cubana de Pediatría, 2017. 89(2): p. 165-176.
  21. Marghli, S., et al., Nebulized budesonide combined with systemic corticosteroid vs systemic corticosteroid alone in acute severe asthma managed in the emergency department: a randomized controlled trial. BMC Emergency Medicine, 2022. 22(1): p. 134.
  22. Pedersen, S., Stef* f* ensen G, Ekman I, et al. Pharmacokinetics of budesonide in children with asthma. Eur J Clin Pharmaco, 1987. 31: p. 579-582.
  23. Barnes, P.J., Inhaled corticosteroids. Pharmaceuticals, 2010. 3(3): p. 514-540.
  24. Horvath, G. and A. Wanner, Inhaled corticosteroids: effects on the airway vasculature in bronchial asthma. European Respiratory Journal, 2006. 27(1): p. 172-187.
  25. Mendes, E., et al., Comparative bronchial vasoconstrictive efficacy of inhaled glucocorticosteroids. European Respiratory Journal, 2003. 21(6): p. 989-993.
  26. Agertoft, L., et al., Systemic availability and pharmacokinetics of nebulised budesonide in preschool children. Archives of disease in childhood, 1999. 80(3): p. 241-247.
  27. DiGiulio, G., et al., Hospital treatment of asthma: lack of benefit from theophylline given in addition to nebulized albuterol and intravenously administered corticosteroid. The Journal of pediatrics, 1993. 122(3): p. 464-469.
  28. Rodriguez-Martinez, C.E., M.P. Sossa-Briceño, and J.A. Castro-Rodriguez, Advantage of inhaled corticosteroids as additional therapy to systemic corticosteroids for pediatric acute asthma exacerbations: a cost-effectiveness analysis. Journal of Asthma, 2020. 57(9): p. 949-958.