Acetylcysteine combined with budesonide nebulized inhalation for the treatment of pneumonia in children: a meta-analysis

This study aims to evaluate the clinical efficacy and adverse effects of nebulized acetylcysteine combined with budesonide for treating childhood pneumonia, providing a theoretical foundation for its clinical application. Randomized controlled trials investigating the use of acetylcysteine with budesonide nebulized inhalation for treating pediatric pneumonia were identified through searches in PubMed, EMBASE, Cochrane Library, CNKI, Wanfang Medical Network, VIP, and the Chinese Biomedical Literature Service System. The search period extended from the inception to November 2024. The data analysis was conducted using Review Manager 5.3 and Stata software. For dichotomous outcomes, risk ratios (RR) with 95% confidence intervals (CI) were calculated; for continuous outcomes, standardized mean differences (SMD) with 95% CI were used. Eligible studies were assessed for bias using the Cochrane risk-of-bias tool. Two investigators independently performed literature screening, data extraction, and risk-of-bias assessment. A comprehensive analysis of 30 included studies (enrolling 3,683 pediatric pneumonia patients) demonstrated that nebulized acetylcysteine-budesonide combination therapy significantly improved overall response rate RR = 1.13, 95% CI: 1.10 to 1.16; P < 0.00001, time to dyspnea resolution SMD = -1.75, 95% CI: -2.19 to -1.30; P < 0.00001, time to rales resolution SMD = -2.23, 95% CI: -2.72 to -1.75; P < 0.00001, time to cough resolution SMD = -2.52, 95% CI: -3.01 to -2.03; P < 0.00001, time to normalization of body temperature SMD = -2.31, 95% CI: -2.97 to -1.65; P < 0.00001, while reducing adverse events RR = 0.63, 95% CI: 0.47 to 0.85; P = 0.003. The combination of nebulized inhaled acetylcysteine and budesonide significantly enhances clinical outcomes and lowers adverse effect incidence in pediatric pneumonia treatment. However, as this analysis primarily incorporated studies from China, and given the substantial heterogeneity observed for some outcomes alongside potential publication bias, these findings should be interpreted with caution and warrant further robust validation by future high-quality, multi-center RCTs.