Observation of the beneficial effects of nasal saline irrigation combined with inhaled budesonide on acute asthma exacerbations in children: a retrospective study

Background Acute asthma exacerbations remain a major cause of morbidity in children. While inhaled budesonide is a cornerstone of acute management, concurrent upper-airway inflammation may limit treatment efficacy. This study aimed to evaluate the clinical effects of nasal saline irrigation combined with inhaled budesonide in children with acute asthma exacerbations. Methods This retrospective study was conducted at Beijing Chaoyang Hospital, Capital Medical University. Children aged 1–14 years who were treated for acute asthma exacerbations were divided into a control group (inhaled budesonide alone) and a combination group (inhaled budesonide plus nasal saline irrigation). Clinical symptom scores, peripheral oxygen saturation (SpO₂), respiratory rate, length of hospital stay, and adverse events were compared between the two groups. The study was approved by the institutional ethics committee (BJCY-26-371). Results A total of 186 children were included (control group, n = 92; combination group, n = 94). Baseline characteristics were comparable between groups. The combination group showed significantly faster reductions in total and nasal symptom scores, more rapid improvement in SpO₂ and respiratory rate at 24–72 h, and a shorter median length of hospital stay (4.0 vs. 5.0 days, P = 0.003) compared with the control group. The requirement for additional systemic corticosteroids was also lower in the combination group. Nasal saline irrigation was well tolerated, with only mild, self-limiting adverse events reported. Conclusions Nasal saline irrigation combined with inhaled budesonide was associated with faster clinical improvement and a shorter hospital stay in children with acute asthma exacerbations compared with inhaled budesonide alone, without increasing adverse events. These findings support the potential value of nasal saline irrigation as a simple adjunctive therapy in this setting.