A Systematic Review of Long-Acting b2-Agonists Versus Higher Doses of Inhaled Corticosteroids in Asthma

OBJECTIVE: To compare the efficacy of inhaled corticosteroids (ICS) plus long-acting b2 agonist (LABA) versus higher doses of ICS in children/adolescents with uncontrolled persistent asthma. METHODS: Randomized, prospective, controlled trials published January 1996 to January 2012 with a minimum of 4 weeks of LABA +ICS versus higher doses of ICS were retrieved through Medline, Embase, Central, and manufacturer’s databases. The primary outcome was asthma exacerbations requiring systemic corticosteroids; secondary outcomes were the pulmonary function test (PEF), withdrawals during the treatment period, days without symptoms, use of rescue medication, and adverse events. RESULTS: Nine studies (n = 1641 patients) met criteria for inclusion (7 compared LABA+ICS versus double ICS doses and 2 LABA+ICS versus higher than double ICS doses). There was no statistically significant difference in the number of patients with asthma exacerbations requiring systemic corticosteroids between children receiving LABA +ICS and those receiving higher doses of ICS (odds ratio = 0.76; 95% confidence interval: 0.48–1.22, P = .25, I = 16%). In the subgroup analysis, patients receiving LABA+ICS showed a decreased risk of asthma exacerbations compared with higher than twice ICS doses (odds ratio = 0.48; 95% confidence interval: 0.28–0.82, P = .007, I= 0). Children treated with LABA+ICS had significantly higher PEF, less use of rescue medication, and higher short-term growth than those on higher ICS doses. There were no other significant differences in adverse events. CONCLUSIONS: There were no statistically significant group differences between ICS+LABA and double doses of ICS in reducing the incidence of asthma exacerbations but it did decrease the risk comparing to higher than double doses of ICS. Pediatrics 2012;130:e650–e657 AUTHORS: Jose A. Castro-Rodriguez, MD, PhD,a and Gustavo J. Rodrigo, MDb aDepartments of Family Medicine and Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile; and bDepartamento de Emergencia, Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay