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J Allergy Clin Immunol Pract. 2020 Jan 29. pii: S2213-2198(20)30100-8. doi: 10.1016/j.jaip.2020.01.042. [Epub ahead of print]

Nebulized Inhaled Corticosteroids in Asthma Treatment in Children ≤5 Years of Age: A Systematic Review and Global Expert Analysis.

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Department of Pediatrics, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China.
Division of Allergy and Clinical Immunology, Federal University of São Paulo, São Paulo, Brazil.
Boys Town National Research Hospital, Omaha, NE. Electronic address:
Hospital Médica Sur Clinical Foundation and Hospital, Mexico City, Mexico.
Cairo University, Cairo, Egypt.
Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Department of Pediatrics, Moscow, Russia.
University of Southern Denmark, Odense, and Department of Pediatrics, Kolding Hospital, Kolding, Denmark.


Although nebulized corticosteroids (NebCS) are a key treatment option for young children with asthma or viral-induced wheezing (VIW), there are no uniform recommendations on their best use. This systematic review aims to clarify the role of NebCS in children aged ≤5 years for the management of acute asthma exacerbations, asthma maintenance therapy and for the treatment of VIW. Electronic databases were used to identify relevant English language articles with no date restrictions. Studies reporting efficacy data in children aged ≤5 years, with a double-blind, placebo- or open-controlled, randomized design, and inclusion of ≥40 participants (no lower patient limit for VIW) were included. Ten articles on asthma exacerbation, 9 on asthma maintenance, and 7 on VIW were identified. Results showed NebCS to be at least as efficacious as oral corticosteroids in the emergency room (ER) for the management of mild-to-moderate asthma exacerbations. In asthma maintenance, nebulized budesonide, the agent of focus in all trials analyzed, significantly reduced the risk of further asthma exacerbations compared with placebo, cromolyn sodium, and montelukast. Intermittent NebCS treatment of VIW was as effective as continuous daily treatment. In summary, NebCS are effective and well tolerated in patients aged ≤5 years for the management of acute and chronic asthma.


Nebulization; asthma; asthma exacerbation; asthma maintenance; beclomethasone; budesonide; fluticasone; inhaled corticosteroids; pediatric; viral-induced wheezing


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