Comparison of an Inhaled Corticosteroid (Triamcinolone Acetonide) to a Long–Acting Bronchodilator (Salmeterol), the Combination, and Placebo in Mild–Moderate Adult Asthmatic Patients

Addition of long-acting beta2-agonists to inhaled steroids as first line therapy for persistent asthma in steroid-naive adults and children

“…Participants were all naive to both long-acting ß2-agonists and inhaled corticosteroids; that is, they had never received inhaled corticosteroids (Creticos 1999; GOAL (stratum 1); Karaman 2007; Nelson 2003; Prieto 2005), had not received any inhaled corticosteroids for a minimum of one to six months (Boonsawat 2008; Di Franco 1999; Grutters 1999; Kerwin 2008; Miraglia del Giudice 2007; Murray 2004; O’Byrne 2001; Overbeek 2005; Pearlman 1999a; Pearlman 1999b; Rojas 2007; SAS30021; SAS40068; SLGF75; Sorkness 2007; Stelmach 2008; Strand 2004; Weersink 1997), or had abstained from corticosteroids for an unspecified period (Chuchalin 2002; Chuchalin 2008). In an additional study, the participants were described as uncontrolled at step 1 of the British Thoracic Society (BTS) guidelines (SAS30015), and therefore we considered them to be steroid naive, since these guidelines do not recommend the introduction of inhaled corticosteroids until step 2.…”

“…Ten studies (Chuchalin 2002; GOAL; Kerwin 2008; Miraglia del Giudice 2007; Murray 2004; Nelson 2003; Overbeek 2005; Pearlman 1999a; Pearlman 1999b; Rojas 2007) recruited patients with moderate airway obstruction (mean baseline FEV1 of 66% to 79% of predicted), whilst 12 trials recruited patients with minimal airway obstruction, for example, a mean baseline FEV1 of predicted 80% to 105% of predicted (Boonsawat 2008; Chuchalin 2008; Creticos 1999; Di Franco 1999; Grutters 1999; O’Byrne 2001; Prieto 2005; SAM40034; SAM40036; Sorkness 2007; Stelmach 2008; Weersink 1997). For six studies (including four accessed from the GSK trials register), we were unable to determine baseline FEV1 predicted (Karaman 2007; SAS30015; SAS30021; SAS40068; SLGF75; Strand 2004).…”

“…Fourteen studies tested the combination of LABA and low doses of inhaled corticosteroids (i.e. 200 to 400 μg/day of beclomethasone, or equivalent: Boonsawat 2008; Chuchalin 2002; Chuchalin 2008; Creticos 1999; Murray 2004; Nelson 2003; O’Byrne 2001; Overbeek 2005; Pearlman 1999a; Prieto 2005; SAS30015; SAS40068; SLGF75; Strand 2004). One study assessed LABA added to 500 mcg of beclomethasone equivalent (Kerwin 2008) and nine studies used high doses (i.e.…”

“…Studies assessed the addition of LABA to beclomethasone (three studies: Di Franco 1999; Grutters 1999; SAS30015), budesonide (seven studies: Chuchalin 2002; Karaman 2007; Miraglia del Giudice 2007; O’Byrne 2001; Overbeek 2005; SAM40036; Stelmach 2008), triamcinolone (one study: Creticos 1999) or fluticasone (17 studies: Boonsawat 2008; Chuchalin 2008; GOAL; Kerwin 2008; Murray 2004; Nelson 2003; Pearlman 1999a; Pearlman 1999b; Prieto 2005; Rojas 2007; SAM40034; SAS30021; SAS40068; SLGF75; Sorkness 2007; Strand 2004; Weersink 1997).…”

“…Fifteen studies tested the combination of long-acting ß2-agonist and corticosteroid administered in a single inhaler (Boonsawat 2008; Chuchalin 2008; GOAL; Grutters 1999; Kerwin 2008; Murray 2004; Nelson 2003; Prieto 2005; Rojas 2007; SAM40034; SAM40036; SAS30015; SAS30021; SAS40068; Strand 2004). Thirteen studies used two separate inhalers (Chuchalin 2002; Creticos 1999; Di Franco 1999; Karaman 2007; Miraglia del Giudice 2007; O’Byrne 2001; Overbeek 2005; Pearlman 1999a; Pearlman 1999b; SLGF75; Sorkness 2007; Stelmach 2008; Weersink 1997). Compliance was monitored during the intervention period in only five studies (Di Franco 1999; Grutters 1999; Pearlman 1999a; Pearlman 1999b; Sorkness 2007).…”