Beclomethasone versus placebo for chronic asthma

Adams, Nick; Bestall, Janine C; Malouf, Reem; Lasserson, Toby J; Jones, Paul

doi:10.1002/14651858.cd002738.pub2

Cited by 78 publications

(40 citation statements)

References 79 publications

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“…This MCD metric is defined a ⩾0.50 SMD effect size [37,38]. Indeed, this magnitude of effect is very close to that observed in asthma in clinical trials of moderate doses of inhaled beclomethasone (SMD 0.49, 95% CI 0.30-0.69) [39]. Using the metric of FEV1 absolute change (standardised to an adult male) available for 21 of the included substudies, HACT appears to be almost as potent compared with the maximum estimated pooled effect of inhaled budesonide for asthma in clinical trials (229 versus 290 mL) [40].…”

Section: Discussionmentioning

confidence: 63%

High-altitude alpine therapy and lung function in asthma: Systematic review and meta-analysis

Vinnikov

Khafagy

Blanc

et al. 2016

6.2 Occupational and Environmental Health

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We used meta-analysis to measure the effect of high-altitude climate therapy (HACT) on lung function outcomes in asthma, and systematically searched PubMed, Embase and www.elibrary.ru for publications appearing from 1970 to mid-2015. We included studies carried out with children or adults with an exposure of up to 12 weeks at an altitude of ⩾1500 m above sea level. Changes in forced expiratory volume in 1 s (FEV1), FEV1/vital capacity ratio or peak expiratory flow rate as the HACT intervention outcomes were analysed. We included data for 907 participants (age range 4-58 years) from 21 studies, altogether including 28 substrata based on asthma type or severity. Only three of 21 included studies had high quality, whereas 93% of substudies reported lung function improvement with an overall pooled standardised mean difference (SMD) of 0.53 (95% CI 0.43-0.62). The measured effect of HACT was greater in adults (SMD 0.75, 95% CI 0.63-0.88, n=14) than in children (SMD 0.24, 95% CI 0.09-0.38, n=14). Studies at altitude >2000 m above sea level yielded the same effect as those at lower altitude. Based on a cut-point of a 0.50 change in SMD to define a meaningful clinical difference, HACT appears to have efficacy as an intervention. This extent of benefit appears to be limited to adults with asthma. @ERSpublications High-altitude alpine therapy may be an effective intervention to improve lung function in patients with asthma

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Section: Discussionmentioning

confidence: 63%

High-altitude alpine therapy and lung function in asthma: Systematic review and meta-analysis

Vinnikov

Khafagy

Blanc

et al. 2016

6.2 Occupational and Environmental Health

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“…Três revisões sistemáticas mostraram que BDP, BUD e FP promovem melhora significativa da função pulmonar, avaliada pelo volume expiratório forçado no primeiro segundo (FEV 1 ) e pelo pico de fluxo expiratório (PEF); menor freqüência de exacerbações da asma; melhora dos sintomas e menor necessidade do uso de beta-2 agonistas em qualquer dose diária, comparativamente a placebo [21][22][23] .…”

Section: Eficácia Clínicaunclassified

“…Evidências atuais mostram que o tratamento com CEI (doses média/elevada) pode induzir desaceleração do ritmo de crescimento ao início do tratamento com DPB 19,21,44 ou BUD 19,22 . Entretanto, essa interferência é transitória, uma vez que não se documenta o comprometimento da estatura desses pacientes na idade adulta 19 .…”

Section: Crescimento Linearunclassified

Inhaled corticosteroids in the treatment of respiratory allergy: safety vs. efficacy

Rizzo

Solé

2006

J Pediatr (Rio J)

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Objective: Review the molecular mechanisms of action, efficacy, and potential side effects associated with inhaled corticosteroids (ICS) in children with persistent asthma.Sources: Articles in English from MEDLINE. The following terms were used: corticosteroids, inhaled corticosteroids, asthma, children, beclomethasone, fluticasone, budesonide, ciclesonide, growth, adrenal insufficiency, bone mineral density, and oral candidiasis. Treatment guidelines, review articles, controlled trials, meta-analyses, and systematic reviews evaluating the efficacy and the adverse events of treatment with ICS were selected.Summary of the findings: In vivo and in vitro studies show that t h e a v a i l a b l e I C S h a v e d i f f e r e n t p h a r m a c o k i n e t i c a n d pharmacodynamic properties that result in different action potentials. ICS also differ as to the systemic and local side effects. The bioavailability of these products is essential in order to determine the incidence of side effects. In general, ICS are capable of controlling asthma, reducing the number of exacerbations, medical consultations, hospitalizations, and the need of oral corticosteroid (applications) bursts. Improvement can also be seen in pulmonary function, especially in patients with recent onset asthma. The most documented adverse effect is transitory decrease of growth rate.Conclusions: ICS are the main anti-inflammatory agent used to treat persistent asthma. When administered in low doses, they seem to be safe and effective. Patient monitoring allows for early detection of possible side effects associated with ICS.J Pediatr (Rio J). 2006;82(5 Suppl):S198-205: Children, asthma, inhaled corticosteroids, budesonide, beclomethasone, fluticasone, ciclesonide. ResumoObjetivo: Revisar os mecanismos moleculares de ação, eficácia e potenciais efeitos adversos relacionados aos corticosteróides inalados (CEI) em crianças com asma persistente.Fontes dos dados: Artigos de língua inglesa da base de dados MEDLINE. Foram empregados os termos: corticosteroids, inhaled corticosteroids, asthma, children, beclomethasone, fluticasone, budesonide, ciclesonide, growth, adrenal insufficiency, bone mineral density, oral candidiasis. Foram selecionados guias de tratamento, artigos de revisão, estudos controlados, meta-análises e revisões sistemáticas que avaliaram a eficácia e os eventos adversos do tratamento com CEI. Síntese dos dados:Estudos in vivo e in vitro mostram que os CEI disponíveis apresentam diferentes características farmacociné-ticas e farmacodinâmicas que lhes conferem diferentes potenciais de ação. Os CEI também diferem quanto aos efeitos adversos sistêmicos e locais. Salienta-se a biodisponibilidade desses produtos como essencial para determinar a incidência de efeitos colaterais. Em linhas gerais, os CEI são capazes de controlar a asma, reduzindo o número de exacerbações, atendimentos médicos, hospitalizações e a necessidade de pulsos de corticosteróides orais. Também se observa melhora da função pulmonar, sobretudo nos pacientes com asma ...

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“…ICSs should be considered for patients with any of the following asthma-related features: [14][15][16] • an asthma attack in the past 2 years, requiring the use of broncho dilators and systemic steroids • using inhaled SABAs ≥3 times a week • symptomatic ≥3 times a week • nocturnal waking ≥1 times a week.…”

Section: Treatment Optionsmentioning

confidence: 99%

“…[13][14][15] Treatment with low-dose ICSs reduces asthma symptoms, improves lung function and quality of life, and reduces the risk of exacerbations, asthma-related hospitalisations and death (evidence level I). [13,17,18] …”

Section: Treatment Optionsmentioning

confidence: 99%

Asthma treatment in children: A pragmatic approach

Masekela¹,

Jeevanathrum²,

Kling³

et al. 2018

S Afr Med J

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Corresponding author: R Masekela (masekelar@ukzn.ac.za)Background. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, with airway reversibility. Management of chronic inflammation with anti-asthma medication improves asthma control and quality of life. Objectives. To provide an evidence-based approach for chronic asthma management in young children and adolescents and provide guidance on the use of new asthma drugs in children. Methods. The South African Childhood Asthma Working Group (SACAWG) convened in January 2017. The asthma treatment task group reviewed the available scientific literature and international asthma treatment guidelines. The evidence was then graded according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system and recommendations were made based on scientific evidence and local context. Asthma management recommendations were made for children ˂6 years of age and older children and adolescents, as well as for stepping up and stepping down of therapy. This review does not include biologics or novel asthma drugs, which are covered in another CME article in this edition of SAMJ. Conclusions. To ensure good response, treatment and adherence, type of medication, device and checking of technique are all critical.Stepping up of therapy should be done only after ensuring good adherence and technique. Once therapeutic response is achieved, medication administration has to be stepped down to improve ease of use and avoid unnecessary side-effects.

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Beclomethasone versus placebo for chronic asthma

Abstract: Analysis 1.3. Comparison 1 CFC-BDP versus Placebo, not on oral steroids: 400 mcg/d or less, Outcome 3 Change in FEV1 (%)...... Analysis 1.4. Comparison 1 CFC-BDP versus Placebo, not on oral steroids: 400 mcg/d or less, Outcome 4 FVC (L).

Cited by 78 publications

References 79 publications

High-altitude alpine therapy and lung function in asthma: Systematic review and meta-analysis

High-altitude alpine therapy and lung function in asthma: Systematic review and meta-analysis

Inhaled corticosteroids in the treatment of respiratory allergy: safety vs. efficacy

Asthma treatment in children: A pragmatic approach

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