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

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.