Long-acting beta2-agonists versus placebo in addition to inhaled corticosteroids in children and adults with chronic asthma.

Abstract:

BACKGROUND:Long-acting inhaled beta2-adrenergic agonists are recommended as 'add-on' medication to inhaled corticosteroids in the maintenance therapy of asthmatic adults and children aged two years and above. OBJECTIVES:To quantify in asthmatic patients the safety and efficacy of the addition of long-acting beta2-agonists to inhaled corticosteroids on the incidence of asthma exacerbations, pulmonary function and other measures of asthma control. SEARCH STRATEGY:We identified randomised controlled trials (RCTs) through electronic database searches (the Cochrane Airways Group Specialised Register, MEDLINE, EMBASE and CINAHL), bibliographies of RCTs and correspondence with manufacturers, until April 2004. SELECTION CRITERIA:RCTs were included that compared the addition of inhaled long-acting beta2-agonists to corticosteroids with inhaled corticosteroids alone for asthma therapy in children aged two years and above and in adults. DATA COLLECTION AND ANALYSIS:Studies were assessed independently by two review authors for methodological quality and data extraction. Confirmation was obtained from the trialists when possible. The primary endpoint was rate of asthma exacerbations requiring systemic corticosteroids. Secondary endpoints included pulmonary function tests (PFTs), symptom scores, adverse events and withdrawal rates. MAIN RESULTS:Of 594 identified citations, 49 trials met the inclusion criteria: 27 full-text publications, one unpublished full-text report and 21 abstracts. Twenty-three citations (21 abstracts and two full-text publications) provided data in insufficient detail, 26 trials contributed to this systematic review. All but three trials were of high methodological quality. Most interventions (N = 26) were of four-month duration or less. Eight trials focused on children and 18 on adults, with participants generally symptomatic with moderate airway obstruction despite their current inhaled steroid regimen. If a trial had more than one intervention or control group, additional control to intervention comparisons were considered separately. Formoterol (N = 17) or salmeterol (N = 14) were most frequently added to low-dose inhaled corticosteroids (200 to 400 microg/day of beclomethasone (BDP) or equivalent). The addition of a daily long-acting beta2-agonist (LABA) reduced the risk of exacerbations requiring systemic steroids by 19% (relative risk (RR) 0.81, 95% CI 0.73 to 0.90). The number needed to treat for one extra patient to be free from exacerbation for one year was 18 (95% CI 13 to 33). The addition of LABA significantly improved FEV1 (weighted mean difference (WMD) 170 mL, 95% CI 110 to 240) using a random-effects model, increased the proportion of symptom-free days (WMD 17%, 95% CI 12 to 22, N = 6 trials) and rescue-free days (WMD 19%, 95% CI 12 to 26, N = 2 trials). The group treated with LABA plus inhaled corticosteroid showed a reduction in the use of rescue short-acting beta2-agonists (WMD -0.7 puffs/day, 95% CI -1.2 to -0.2), experienced less withdrawals due to poor asthma control (RR 0.5, 95% CI 0.4 to 0.7) and less withdrawals due to any reason (RR 0.9, 95% CI 0.8 to 0.98), using a random-effects model. There was no group difference in risk of overall adverse effects (RR 0.98, 95% CI 0.92 to 1.05), withdrawals due to adverse health events (RR 1.29, 95% CI 0.96 to 1.75) or specific adverse health events. AUTHORS' CONCLUSIONS:In patients who are symptomatic on low to high doses of inhaled corticosteroids, the addition of a long-acting beta2-agonist reduces the rate of exacerbations requiring systemic steroids, improves lung function, symptoms and use of rescue short-acting beta2-agonists. The similar number of serious adverse events and withdrawal rates in both groups provides some indirect evidence of the safety of long-acting beta2-agonists as add-on therapy to inhaled corticosteroids.

authors

Ni Chroinin M,Greenstone IR,Danish A,Magdolinos H,Masse V,Zhang X,Ducharme FM

doi

10.1002/14651858.CD005535

keywords:

subject

Has Abstract

pub_date

2005-10-19 00:00:00

pages

CD005535

issue

4

issn

1469-493X

pub_type

杂志文章,meta分析,评审
  • Pit and fissure sealants for preventing dental decay in permanent teeth.

    abstract:BACKGROUND:Dental sealants were introduced in the 1960s to help prevent dental caries, mainly in the pits and fissures of occlusal tooth surfaces. Sealants act to prevent bacteria growth that can lead to dental decay. Evidence suggests that fissure sealants are effective in preventing caries in children and adolescents...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001830.pub5

    authors: Ahovuo-Saloranta A,Forss H,Walsh T,Nordblad A,Mäkelä M,Worthington HV

    更新日期:2017-07-31 00:00:00

  • Influenza vaccines for preventing acute otitis media in infants and children.

    abstract:BACKGROUND:Acute otitis media (AOM) is one of the most common infectious diseases in children. It has been reported that 64% of infants have an episode of AOM by the age of six months and 86% by one year. Although most cases of AOM are due to bacterial infection, it is commonly triggered by a viral infection. In most c...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD010089.pub3

    authors: Norhayati MN,Ho JJ,Azman MY

    更新日期:2017-10-17 00:00:00

  • Advanced trauma life support training for ambulance crews.

    abstract:BACKGROUND:There is an increasing global burden of disease from injuries. Models of trauma care initially developed in high-income countries are also being adopted in low and middle-income countries (LMIC). Amongst these ambulance crews with Advanced Life Support (ALS) training are being promoted in LMIC as a strategy ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003109

    authors: Sethi D,Kwan I,Kelly AM,Roberts I,Bunn F

    更新日期:2001-01-01 00:00:00

  • Hypnotherapy for treatment of irritable bowel syndrome.

    abstract:BACKGROUND:Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder of unknown aetiology. Current pharmacological treatments have limited value. Hypnotherapy has been reported to have beneficial effects for IBS symptoms. OBJECTIVES:To evaluate the efficacy of hypnotherapy for the treatment of ir...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD005110.pub2

    authors: Webb AN,Kukuruzovic RH,Catto-Smith AG,Sawyer SM

    更新日期:2007-10-17 00:00:00

  • Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents.

    abstract:BACKGROUND:Vomiting caused by acute gastroenteritis is very common in children and adolescents. Treatment of vomiting in children can be problematic and the use of antiemetics remains a controversial issue. There have been concerns expressed about apparently unacceptable levels of side effects such as sedation and extr...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD005506.pub2

    authors: Alhashimi D,Alhashimi H,Fedorowicz Z

    更新日期:2006-07-19 00:00:00

  • Glucocorticoids for acute viral bronchiolitis in infants and young children.

    abstract:BACKGROUND:Previous systematic reviews have not shown clear benefit of glucocorticoids for acute viral bronchiolitis, but their use remains considerable. Recent large trials add substantially to current evidence and suggest novel glucocorticoid-including treatment approaches. OBJECTIVES:To review the efficacy and safe...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD004878.pub3

    authors: Fernandes RM,Bialy LM,Vandermeer B,Tjosvold L,Plint AC,Patel H,Johnson DW,Klassen TP,Hartling L

    更新日期:2010-10-06 00:00:00

  • Interventions for rosacea.

    abstract:BACKGROUND:Rosacea is a common skin condition affecting the face, characterised by flushing, redness, pimples, pustules and dilated blood vessels. The eyes are often also involved. The cause of rosacea is unclear. It is a chronic disease, which can be controlled in most cases with appropriate treatment. Numerous treatm...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD003262.pub2

    authors: van Zuuren EJ,Graber MA,Hollis S,Chaudhry M,Gupta AK

    更新日期:2004-01-01 00:00:00

  • Potassium binders for chronic hyperkalaemia in people with chronic kidney disease.

    abstract:BACKGROUND:Hyperkalaemia is a common electrolyte abnormality caused by reduced renal potassium excretion in patients with chronic kidney diseases (CKD). Potassium binders, such as sodium polystyrene sulfonate and calcium polystyrene sulfonate, are widely used but may lead to constipation and other adverse gastrointesti...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD013165.pub2

    authors: Natale P,Palmer SC,Ruospo M,Saglimbene VM,Strippoli GF

    更新日期:2020-06-26 00:00:00

  • Telephone counselling for smoking cessation.

    abstract:BACKGROUND:Telephone services can provide information and support for smokers. Counselling may be provided proactively or offered reactively to callers to smoking cessation helplines. OBJECTIVES:To evaluate the effect of proactive and reactive telephone support to help smokers quit. SEARCH STRATEGY:We searched the Co...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD002850

    authors: Stead LF,Lancaster T

    更新日期:2001-01-01 00:00:00

  • Medical day hospital care for the elderly versus alternative forms of care.

    abstract:BACKGROUND:The proportion of the world's population aged 60 or over is increasing. This review sets out to examine the effectiveness and resource implications of geriatric medical day hospital attendance for elderly people. This is an update of a Cochrane review first published in 1999. OBJECTIVES:To examine the effec...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD001730.pub2

    authors: Forster A,Young J,Lambley R,Langhorne P

    更新日期:2008-10-08 00:00:00

  • Effect of partogram use on outcomes for women in spontaneous labour at term.

    abstract:BACKGROUND:The partogram (sometimes known as partograph) is usually a pre-printed paper form, on which labour observations are recorded. The aim of the partogram is to provide a pictorial overview of labour, to alert midwives and obstetricians to deviations in maternal or fetal wellbeing and labour progress. Charts oft...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD005461.pub2

    authors: Lavender T,Hart A,Smyth RM

    更新日期:2008-10-08 00:00:00

  • Antidepressants for smoking cessation.

    abstract:BACKGROUND:There are two reasons to believe antidepressants might help in smoking cessation. First, depression may be a symptom of nicotine withdrawal, and smoking cessation sometimes precipitates depression. Second, smoking appears to be due, in part, to deficits in dopamine, serotonin and norepinephrine, all of which...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD000031

    authors: Hughes JR,Stead LF,Lancaster T

    更新日期:2000-01-01 00:00:00

  • Interventions for increasing acceptance of local anaesthetic in children and adolescents having dental treatment.

    abstract:BACKGROUND:Delivery of pain-free dentistry is crucial for reducing fear and anxiety, completion of treatment, and increasing acceptance of future dental treatment in children. Local anaesthetic (LA) facilitates this pain-free approach but it remains challenging. A number of interventions to help children cope with deli...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析

    doi:10.1002/14651858.CD011024.pub2

    authors: Monteiro J,Tanday A,Ashley PF,Parekh S,Alamri H

    更新日期:2020-02-27 00:00:00

  • Interventions for cough in cancer.

    abstract:BACKGROUND:Cough is a common symptom in patients with malignancies, especially in patients with lung cancer. Cough is not well controlled in clinical practice and clinicians have few management options to treat it. OBJECTIVES:The primary objective of this review was to determine the effectiveness of interventions, bot...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD007881.pub2

    authors: Molassiotis A,Bailey C,Caress A,Brunton L,Smith J

    更新日期:2010-09-08 00:00:00

  • Dietary advice for illness-related malnutrition in adults.

    abstract:BACKGROUND:Illness-related malnutrition has been reported in 10% to 55% of ill people in hospital and the community in areas of food sufficiency. Dietary advice encouraging the use of energy- and nutrient-rich foods rather than oral nutritional supplements has been suggested for managing illness-related malnutrition. ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD002008.pub3

    authors: Baldwin C,Weekes CE

    更新日期:2008-01-23 00:00:00

  • Diet or exercise, or both, for weight reduction in women after childbirth.

    abstract:BACKGROUND:Weight retention after pregnancy may contribute to obesity. It is known that diet and exercise are recommended components of any weight loss programme in the general population. However, strategies to achieve healthy body weight among postpartum women have not been adequately evaluated. OBJECTIVES:The objec...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD005627.pub2

    authors: Amorim AR,Linne YM,Lourenco PM

    更新日期:2007-07-18 00:00:00

  • Physical activity programs for promoting bone mineralization and growth in preterm infants.

    abstract:BACKGROUND:Lack of physical stimulation may contribute to metabolic bone disease of preterm infants, resulting in poor bone mineralization and growth. Physical activity programs combined with adequate nutrition might help to promote bone mineralization and growth. OBJECTIVES:The primary objective was to assess whether...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD005387.pub3

    authors: Schulzke SM,Kaempfen S,Trachsel D,Patole SK

    更新日期:2014-04-22 00:00:00

  • Vigabatrin versus carbamazepine monotherapy for epilepsy.

    abstract:BACKGROUND:This is an update of a Cochrane review first published in 2012 (Cochrane Database of Systematic Reviews 2012, Issue 1).The efficacy and safety of vigabatrin (VGB) as an add-on therapy for refractory epilepsy have been well established. However, this information needs to be weighed against the risk of develop...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD008781.pub3

    authors: Xiao Y,Gan L,Wang J,Luo M,Luo H

    更新日期:2015-11-18 00:00:00

  • Topical antibiotics without steroids for chronically discharging ears with underlying eardrum perforations.

    abstract:BACKGROUND:Chronic suppurative otitis media (CSOM) causes ear discharge and impairs hearing. OBJECTIVES:Assess topical antibiotics (excluding steroids) for treating chronically discharging ears with underlying eardrum perforations (CSOM). SEARCH STRATEGY:The Cochrane Ear, Nose and Throat Disorders Group Trials Regist...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD004618.pub2

    authors: Macfadyen CA,Acuin JM,Gamble C

    更新日期:2005-10-19 00:00:00

  • Local intramuscular transplantation of autologous mononuclear cells for critical lower limb ischaemia.

    abstract:BACKGROUND:Peripheral arterial disease is a major health problem, and in about 1% to 2% of patients the disease progresses to critical limb ischaemia (CLI). In a substantial number of patients with CLI, no effective treatment option other than amputation is available and around a quarter of these patients will require ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD008347.pub3

    authors: Moazzami K,Moazzami B,Roohi A,Nedjat S,Dolmatova E

    更新日期:2014-12-19 00:00:00

  • EEG for children with complex febrile seizures.

    abstract:BACKGROUND:Febrile seizures can be classified as simple or complex. Complex febrile seizures are associated with fever that lasts longer than 15 minutes, occur more than once within 24 hours and are confined to one side of the child's body. It is common in some countries for doctors to recommend an electroencephalograp...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD009196.pub2

    authors: Shah PB,James S,Elayaraja S

    更新日期:2014-01-24 00:00:00

  • Medical day hospital care for the elderly versus alternative forms of care.

    abstract:BACKGROUND:Geriatric day hospitals provide multi-disciplinary rehabilitation in an outpatient setting. Concern has been expressed that evidence for effectiveness is equivocal and that day hospital care is expensive. OBJECTIVES:To assess the effects of medical day hospitals for elderly people. SEARCH STRATEGY:We searc...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD001730

    authors: Forster A,Young J,Langhorne P

    更新日期:2000-01-01 00:00:00

  • Preventive interventions for postnatal psychosis.

    abstract:BACKGROUND:Postnatal psychosis is a worldwide life-threatening condition that affects one to two in every 1000 new mothers. It has an abrupt onset within a month of childbirth. Affected new mothers rapidly develop frank psychosis, cognitive impairment, and disorganised behaviours. Factors that increase the risk of post...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD009991.pub2

    authors: Essali A,Alabed S,Guul A,Essali N

    更新日期:2013-06-06 00:00:00

  • Dietary supplements for established atopic eczema.

    abstract:BACKGROUND:Many people with atopic eczema are reluctant to use the most commonly recommended treatments because they fear the long-term health effects. As a result, many turn to dietary supplements as a possible treatment approach, often with the belief that some essential ingredient is 'missing' in their diet. Various...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD005205.pub3

    authors: Bath-Hextall FJ,Jenkinson C,Humphreys R,Williams HC

    更新日期:2012-02-15 00:00:00

  • Anti-vascular endothelial growth factor for control of wound healing in glaucoma surgery.

    abstract:BACKGROUND:Trabeculectomy is performed as a treatment for glaucoma to lower intraocular pressure (IOP). The surgical procedure involves creating a channel through the wall of the eye. However scarring during wound healing can block this channel which will lead to the operation failing. Anti-vascular endothelial growth ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD009782.pub2

    authors: Cheng JW,Cheng SW,Wei RL,Lu GC

    更新日期:2016-01-15 00:00:00

  • Herbal medicines for viral myocarditis.

    abstract:BACKGROUND:Herbal medicines are being used as a treatment for viral diseases such as viral myocarditis and numerous clinical trials have been conducted to investigate their efficacy. Despite this wealth of evidence, the role of herbal medicines in the treatment of viral myocarditis is yet to be established. This is an ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD003711.pub4

    authors: Liu ZL,Liu ZJ,Liu JP,Kwong JS

    更新日期:2012-11-14 00:00:00

  • Antiviral agents for treatment of herpes simplex virus infection in neonates.

    abstract:BACKGROUND:Herpes simplex virus (HSV) is a rare but serious neonatal pathogen. Prior to the availability of antiviral drugs the mortality associated with all but localised neonatal infection was high, with 85% of infants with disseminated HSV infection and 50% of infants with encephalitis dying by one year of age. The ...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,meta分析,评审

    doi:10.1002/14651858.CD004206.pub2

    authors: Jones CA,Walker KS,Badawi N

    更新日期:2009-07-08 00:00:00

  • Mediastinal chest drain clearance for cardiac surgery.

    abstract:BACKGROUND:Cardiac tamponade may occur following cardiac surgery as a result of blood or fluid collecting in the pericardial space compressing the heart and reducing cardiac output. Mediastinal chest drains (including pericardial drains) are inserted as standard post-operative practice following cardiac surgery to assi...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD003042.pub2

    authors: Wallen M,Morrison A,Gillies D,O'Riordan E,Bridge C,Stoddart F

    更新日期:2004-10-18 00:00:00

  • Endothelial keratoplasty versus penetrating keratoplasty for Fuchs endothelial dystrophy.

    abstract:BACKGROUND:Fuchs endothelial dystrophy (FED), first described by Ernst Fuchsis in 1910, is a condition in which there is premature degeneration of corneal endothelial cells. When the number of endothelial cells is reduced to a significant degree fluid begins to accumulate within the cornea. As a result the cornea loses...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD008420.pub2

    authors: Nanavaty MA,Shortt AJ

    更新日期:2011-07-06 00:00:00

  • Home or foster home care versus institutional long-term care for functionally dependent older people.

    abstract:BACKGROUND:Changing population demographics have led to an increasing number of functionally dependent older people who require care and medical treatment. In many countries, government policy aims to shift resources into the community from institutional care settings with the expectation that this will reduce costs an...

    journal_title:The Cochrane database of systematic reviews

    pub_type: 杂志文章,评审

    doi:10.1002/14651858.CD009844.pub2

    authors: Young C,Hall AM,Gonçalves-Bradley DC,Quinn TJ,Hooft L,van Munster BC,Stott DJ

    更新日期:2017-04-03 00:00:00