Introduction The efficacy of inhaled budesonide for managing moderate-to-severe acute exacerbations in children is not clear.Therefore,this study aimed to evaluate hospital admission rates,need for use of systemic corticosteroids,length of hospital stay and adverse events when inhaled budesonide is added to standard pediatric emergency department management of moderate-to-severe acute exacerbations of asthma.Methods A systematic search was conducted in PubMed,Scopus,CENTRAL(Cochrane Central Register of Controlled Trials)and Google scholar databases.Randomized controlled trials that evaluated the effect of nebulized budesonide in moderate-to-severe acute exacerbations of asthma in pediatric patients were included for this meta-analysis.Statistical analysis was done using STATA version 13.0.Results A total of 16 RCTs were included.Children receiving nebulized budesonide had 43％lower risk of being hospital-ized(RR 0.57;95％CI,0.39;0.85)and 66％lower risk of requiring systemic corticosteroids(RR 0.34;95％CI,0.21;0.55)compared with those receiving placebo.There were no differences in the length of hospital stay(Hedges's g standardized mean difference-1.53;95％CI,-3.64;0.58)and risk of adverse events(RR 0.87,95％CI;0.65;1.17)between the two groups.There was no evidence of publication bias for any of the outcomes considered.Conclusion The findings of this meta-analysis support the use of inhaled budesonide in reducing risk of hospitalization and the need for systemic corticosteroids among children with acute moderate-to-severe asthma exacerbation.