en ریه Pediatric Pulmonology Narrative Review Narrative Review <strong>Background</strong>: Inhaled corticosteroids (ICS) are the primary anti-inflammatory therapy for long-term asthma management, with well-documented benefits in reducing airway inflammation, controlling symptoms, preventing exacerbations, and lowering asthma-related morbidity and mortality. Although systemic corticosteroids (SCS) remain the standard of care for acute exacerbations, the role of high-dose ICSs in this context is not fully established. Some studies&mdash;particularly in pediatric populations&mdash;have suggested potential benefits of early administration of high-dose ICSs, while evidence in adults remains inconclusive.<br> <strong>Objectives</strong>: This narrative review aimed to evaluate nebulized ICS for the treatment or prevention of wheezing and asthma exacerbations, with emphasis on beclomethasone dipropionate (BDP).<br> <strong>Methods</strong>: We reviewed studies published in English, French, Spanish, and Portuguese over the past 25 years in the following databases: PubMed, SciELO, Google Scholar, and the Virtual Health Library. Search terms included: acute asthma OR asthma exacerbation AND beclomethasone OR budesonide AND suspension OR nebulization AND children OR adolescents<br> <strong>Results</strong>: ICS remain the primary anti-inflammatory drug used in asthma therapy. Their effects include both genomic and non-genomic mechanisms. Non-genomic proprieties have rapid onset of action and are exclusive to inhaled formulations, including the well described transient reduction in airway blood flow. Other non-genomic ICS mechanisms studied are the inhibition of mast cell degranulation and relaxation of airway muscle cells.<br> <strong>Conclusions</strong>: Nebulizers are effective devices for inhaled administration, particularly used in young children because they eliminate the need of respiratory coordination. In the treatment of asthma exacerbations, ICS administered in high doses within the first hour of treatment in an emergency department, with or without concomitant SCS, may reduce the risk of hospitalization and decrease the need for SCS in children. Intermittent highdose ICS may be used to prevent asthma exacerbations in young children without persistent symptoms. The efficacy and safety of nebulized BDP have been demonstrated in several pediatric publications across various age groups. Asthma, Children, Exacerbations, Inhaled corticosteroid (ICS) 155 162 http://jpr.mazums.ac.ir/browse.php?a_code=A-10-1386-1&slc_lang=en&sid=1 Gustavo Wandalsen gfwandalsen@unifesp.br 100319475328460013758 100319475328460013758 Yes Pensi Institute, Federal University of São Paulo, São Paulo, Brazil. Marisa Treglia marisa.treglia@chiesi.com 100319475328460013759 0009-0009-9538-3924 No Medical Department, Chiesi Pharmaceuticals of Brazil, São Paulo, Brazil. Marcio Penha marcio.penha@chiesi.com 100319475328460013760 100319475328460013760 No Medical Department, Chiesi Pharmaceuticals of Brazil, São Paulo, Brazil. Simone Dos Dos Reis simone.reis@chiesi.com 100319475328460013761 0009-0004-2918-6221 No Medical Department, Chiesi Pharmaceuticals of Brazil, São Paulo, Brazil. Dirceu Solé sole.dirceu@gmail.com 100319475328460013762 100319475328460013762 No Pensi Institute, Federal University of São Paulo, São Paulo, Brazil.