Key message: intermittent and daily use of inhaled corticosteroids by adults and children with persistent asthma did not significantly differ in the use of rescue oral corticosteroids and the rate of adverse events. Clinicians and patients should carefully weigh up the potential benefits and harms of each treatment option.
People with mild persistent asthma are usually prescribed inhaled corticosteroids (ICS), such as budesonide, to take every day, but many people only take them when their symptoms appear or get worse. This new review from the Cochrane Airways Group looked for evidence from Randomization is the process of randomly dividing into groups the people taking part in a trial. One group (the intervention group) will be given the intervention being tested (for example a drug, surgery, or exercise) and compared with a group which does not receive the intervention (the control group). A trial in which a group (the ‘intervention group’) is given a intervention being tested (for example a drug, surgery, or exercise) is compared with a group which does not receive the intervention (the ‘control group’). (RCTs) comparing these approaches. The authors were interested in how many people had worsening asthma symptoms (exacerbations) needing oral corticosteroids and how many had serious adverse health events. They included six RCTs (four with children, two with adults, 1211 patients) reporting seven comparisons, lasting 12 to 52 weeks, and Data is the information collected through research. were combined. The ICS used was either budesonide or beclomethasone.
What did they find?
- No difference between groups in the number of people experiencing one or more exacerbations needing oral corticosteroids
- No difference between groups in the The speed or frequency of occurrence of an event, usually expressed with respect to time. For instance, a mortality rate might be the number of deaths per year, per 100,000 people. of serious adverse health events
- Compared with those taking ICS intermittently, people taking ICS daily had slightly better asthma control, but children taking daily ICS grew slightly less
- Results were consistent for patients of different ages, asthma severity, trial length and types of rescue Something done with the aim of improving health or relieving suffering. For example, medicines, surgery, psychological and physical therapies, diet and exercise changes. during exacerbations
- No firm conclusions can be made as to the superiority of either approach. Confidence intervals (which show the range within which the true treatment effect is likely to lie) were wide, so the rate of exacerbations may be reduced by as much as 17% or increased by as much as 32%
How good is the evidence?
- This review draws on good quality evidence. All Clinical trials are research studies involving people who use healthcare services. They often compare a new or different treatment with the best treatment currently available. This is to test whether the new or different treatment is safe, effective and any better than what is currently used. No matter how promising a new treatment may appear during tests in a laboratory, it must go through clinical trials before its benefits and risks can really be known. were judged to be of high methodological quality and they were generally at low A way of expressing the chance of an event taking place, expressed as the number of events divided by the total number of observations or people. It can be stated as ‘the chance of falling were one in four’ (1/4 = 25%). This measure is good no matter the incidence of events i.e. common or infrequent. of Any factor, recognised or not, that distorts the findings of a study. For example, reporting bias is a type of bias that occurs when researchers, or others (e.g. drug companies) choose not report or publish the results of a study, or do not provide full information about a study.
- The reviewers note that the outstanding collaboration of the authors or funders of six of the seven comparisons allowed them to obtain additional unpublished data and confirm the methodological quality
- There were few trials available to include in this review and lots of questions remain. For example, the long-term impact of intermittent versus daily ICS on lung growth, airway remodelling (structural changes in the airways caused by long-term unresolved inflammation), bone mineralisation and adrenal function in children, and lung function decline in adults after a year, have yet to be addressed
In the absence of clearer evidence, clinicians and their patients need to consider the potential benefits and harms of each approach to managing persistent asthma. The review contains some helpful suggestions for those designing trials in this area. You can find summaries and podcasts of Cochrane Reviews are systematic reviews. In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. on asthma collected together on the Cochrane Summaries website, from the link below. Here at Evidently Cochrane, we’ll be looking at some new evidence on managing A health condition (or episodes of a health condition) that comes on quickly and is short-lived. asthma later in the week.
Chauhan BF, Chartrand C, Ducharme FM. Intermittent versus daily inhaled corticosteroids for persistent asthma in children and adults. Cochrane Database of In systematic reviews we search for and summarize studies that answer a specific research question (e.g. is paracetamol effective and safe for treating back pain?). The studies are identified, assessed, and summarized by using a systematic and predefined approach. They inform recommendations for healthcare and research. 2013, Issue 2. Art. No.: CD009611. DOI: 10.1002/14651858.CD009611.pub3.
Cochrane summary http://summaries.cochrane.org/CD009611/is-taking-inhaled-corticosteroids-only-when-asthma-symptoms-get-worse-as-safe-and-effective-as-taking-inhaled-corticosteroids-every-day
See also the collection of Cochrane summaries on Cochrane asthma reviews here http://summaries.cochrane.org/search/site/asthma?solrsort=dm_field_version_published%20desc&f=im_field_stage%3A3
This page was last updated: 31 March 2014