Comparative efficacies of nebulized budesonide and systemic corticosteroids in the treatment of exacerbations of chronic obstructive pulmonary disease: A systematic review and meta‐analysis

What is known and objective Corticosteroids are recommended by almost all international guidelines for the management of exacerbations of chronic obstructive pulmonary disease (COPD). Nevertheless, due to their side effects, there are still concerns regarding the use of systemic corticosteroids (SCs). The Global Initiative for Chronic Obstructive Lung Disease guideline states nebulized budesonide (NB) may be a suitable alternative to SCs for treating COPD exacerbations. We conducted this study to systematically compare the efficacies of NB and SCs by using a meta‐analysis. Methods PubMed, EMBASE and Cochrane Library databases were searched from database inception to 10 October 2019. Our main end points were change in pulmonary function and blood gas analysis. Secondary end points were numbers of exacerbations and hyperglycaemia. Results and discussion Of 645 identified studies, 6 were eligible and were included in our analysis (N = 867 participants). Compared with SCs, NB was non‐inferior on the change in FEV1%predicted at 24 hours, 48‐72 hours and 5‐7 days; FEV1 at 5‐7 days; FEV1/FVC at 7 days. For blood gas analysis, our meta‐analysis indicated that PaO2, PaCO2 at 24 hours, 48‐72 hours and 7‐10 days and SaO2 at 24 hours and 7‐10 days showed a non‐significant difference in both groups, whereas the SaO2 was significant higher in NB group at 48‐72 hours after treatment. Hyperglycaemia was less frequent with NB (odds ratio, 0.1; 95% CI, 0.01‐0.85; P = .04). What is new and conclusion Based on our meta‐analysis, NB was not inferior to SCs when used in the treatment of COPD exacerbations. However, additional well‐designed prospective studies are needed to identify the optimal dose of nebulized budesonide and the effects of nebulized budesonide in outpatients, or patients in ICU settings.