Addition of long-acting beta2-agonists to inhaled corticosteroids for chronic asthma in children

• Published in: Cochrane database of systematic reviews 2015-11, Vol.2015 (11), p.CD007949
• Main Authors: Chauhan, Bhupendrasinh F, Chartrand, Caroline, Ni Chroinin, Muireann, Milan, Stephen J, Ducharme, Francine M
• Format: Article
• Language: English
• Subjects: Adolescent; Adrenal Cortex Hormones - administration & dosage; Adrenal Cortex Hormones - adverse effects; Adrenergic beta-Agonists - administration & dosage; Adrenergic beta-Agonists - adverse effects; Albuterol - administration & dosage; Albuterol - analogs & derivatives; Anti-Asthmatic Agents - administration & dosage; Anti-Asthmatic Agents - adverse effects; Asthma - drug therapy; Asthma, chronic ‐ pharmacotherapy; Beclomethasone - administration & dosage; Beclomethasone - adverse effects; Child; Child health; Chronic Disease; Disease Progression; Drug Therapy, Combination; Ethanolamines - administration & dosage; Female; Formoterol Fumarate - administration & dosage; Formoterol Fumarate - adverse effects; Humans; Lungs & airways; Male; Randomized Controlled Trials as Topic; Salmeterol Xinafoate - administration & dosage; Salmeterol Xinafoate - adverse effects
• ISSN: 1469-493X; 1469-493X
• DOI: 10.1002/14651858.cd007949.pub2

Long-acting beta2-agonists (LABA) in combination with inhaled corticosteroids (ICS) are increasingly prescribed for children with asthma. To assess the safety and efficacy of adding a LABA to an ICS in children and adolescents with asthma. To determine whether the benefit of LABA was influenced by baseline severity of airway obstruction, the dose of ICS to which it was added or with which it was compared, the type of LABA used, the number of devices used to deliver combination therapy and trial duration. We searched the Cochrane Airways Group Asthma Trials Register until January 2015. We included randomised controlled trials testing the combination of LABA and ICS versus the same, or an increased, dose of ICS for at least four weeks in children and adolescents with asthma. The main outcome was the rate of exacerbations requiring rescue oral steroids. Secondary outcomes included markers of exacerbation, pulmonary function, symptoms, quality of life, adverse events and withdrawals. Two review authors assessed studies independently for methodological quality and extracted data. We obtained confirmation from trialists when possible. We included in this review a total of 33 trials representing 39 control-intervention comparisons and randomly assigning 6381 children. Most participants were inadequately controlled on their current ICS dose. We assessed the addition of LABA to ICS (1) versus the same dose of ICS, and (2) versus an increased dose of ICS.LABA added to ICS was compared with the same dose of ICS in 28 studies. Mean age of participants was 11 years, and males accounted for 59% of the study population. Mean forced expiratory volume in one second (FEV1) at baseline was ≥ 80% of predicted in 18 studies, 61% to 79% of predicted in six studies and unreported in the remaining studies. Participants were inadequately controlled before randomisation in all but four studies.There was no significant group difference in exacerbations requiring oral steroids (risk ratio (RR) 0.95, 95% confidence interval (CI) 0.70 to 1.28, 12 studies, 1669 children; moderate-quality evidence) with addition of LABA to ICS compared with ICS alone. There was no statistically significant group difference in hospital admissions (RR 1.74, 95% CI 0.90 to 3.36, seven studies, 1292 children; moderate-quality evidence)nor in serious adverse events (RR 1.17, 95% CI 0.75 to 1.85, 17 studies, N = 4021; moderate-quality evidence). Withdrawals occurred significantly less frequently with the addit