Add-on therapy options in asthma not adequately controlled by inhaled corticosteroids: a comprehensive review.

Abstract:

:Many patients with persistent asthma can be controlled with inhaled corticosteroids (ICS). However, a considerable proportion of patients remain symptomatic, despite the use of ICS. We present systematically evidence that supports the different treatment options. A literature search was made of Medline/PubMed to identify randomised and blinded trials. To demonstrate the benefit that can be obtained by increasing the dose of ICS, dose-response studies with at least three different ICS doses were identified. To demonstrate whether more benefit can be obtained by adding long-acting beta2-agonist (LABA), leukotriene antagonist (LTRA) or theophylline than by increasing the dose of ICS, studies comparing these options were identified. Thirdly, studies comparing the different "add-on" options were identified. The addition of a LABA is more effective than increasing the dose of ICS in improving asthma control. By increasing the dose of ICS, clinical improvement is likely to be of small magnitude. Addition of a LTRA or theophylline to the treatment regimen appears to be equivalent to doubling the dose of ICS. Addition of a LABA seems to be superior to an LTRA in improving lung function. However, addition of LABA and LTRA may be equal with respect to asthma exacerbations. However, more and longer studies are needed to better clarify the role of LTRAs and theophylline as add-on therapies.

journal_name

Respir Res

journal_title

Respiratory research

authors

Kankaanranta H,Lahdensuo A,Moilanen E,Barnes PJ

doi

10.1186/1465-9921-5-17

keywords:

subject

Has Abstract

pub_date

2004-10-27 00:00:00

pages

17

eissn

1465-9921

issn

1465-993X

pii

1465-9921-5-17

journal_volume

5

pub_type

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