Increased versus stable dose of inhaled corticosteroids for asthma exacerbations: A systematic review and meta‐analysis

Abstract

Asthma is one of the most common chronic diseases, with an estimated 300 million people affected worldwide. 1 Asthma exacerbations are frightening for patients, associated with considerable morbidity and mortality, and pose a considerable economic burden on the healthcare system. [2][3][4] The daily use of inhaled corticosteroids (ICS) effectively controls the day-to-day asthma symptoms but have only partial efficacy in aborting exacerbations. Asthma guidelines recommend Abstract Background: Increasing the dose of inhaled corticosteroids (ICS) is commonly used at early signs of loss of asthma control. However, the potential benefits and harms of this strategy remain unclear. We performed a systematic review and meta-analysis to compare increased dose with stable dose of ICS among adults and children with asthma. Methods: We searched MEDLINE, EMBASE and Cochrane Central Register ofControlled Trials from inception to August 02, 2018. Randomized clinical trials comparing increased doses vs stable doses of ICS for home management of asthma exacerbations in adults or children were included. Results:The analyses included 8 trials totalling 3866 patients. Four trials were judged as low risk of bias, three were unclear risk, and one was ranked as high risk. Increased dose of ICS was associated with a significantly reduced risk of treatment failure compared with stable dose (OR 0.82, 95% CI 0.70-0.97, I 2 = 6%; 314 (281 to 351) vs 358 events per 1000 patients; moderate-quality evidence). There was no significant difference in unscheduled physician visits or hospital admission between increased or stable dose of ICS. However, increased dose of ICS increased the risk of non-serious adverse events (OR 3.50, 95% CI 1.93-6.35, I 2 = 0%) but not serious adverse events.Conclusions: Current evidence of moderate quality supports increasing the dose of ICS as part of a self-initiated action plan to reduce risk of requiring a course of systemic corticosteroids in people with an asthma exacerbation. However, we did not find evidence for an impact on hospital admissions or unscheduled physician visits, and increased ICS dose increased risk of non-serious adverse events. K E Y W O R D Sasthma, clinical immunology, pharmacology and pharmacogenomics

Ozone Inhalation Attenuated the Effects of Budesonide on Aspergillus fumigatus-Induced Airway Inflammation and Hyperreactivity in Mice

“…Inhaled glucocorticoids improve lung function and airway inflammation in allergic asthma (1, 48, 49) but their effectiveness in acute asthma exacerbations are subject of on-going investigations (49–51). We developed a model in which mice were sensitized (i.p.)…”

“…Inhaled glucocorticoids are currently the main choice for asthma treatment because they can profoundly improve lung function, alleviate airway inflammation and airway hyperreactivity (1, 48, 49) but their effectiveness in acute asthma exacerbations is subject of on-going debate (49–51, 58–60). Studies on asthma exacerbations caused by exposure to air pollutants are limited (61, 62) and the available experimental data on animals (18–20) and humans (21–23) are unclear on whether inhaled corticosteroids are effective to treat O 3 -induced airway inflammation and/or airway hyperreactivity in asthma.…”

Evidence Synthesis in Allergy – A call for submissions

“…Our trusted evidence mission means that we are particularly interested in publishing high‐quality evidence synthesis work in allergy. Historically, our evidence synthesis publications have mainly been simple systematic reviews of intervention trials or observational studies 1–9 . However, we published our journal's first individual participant data meta‐analysis earlier this year 10 and are interested in receiving submissions of other more sophisticated approaches to evidence synthesis, including network meta‐analyses, systematic reviews of prognostic or diagnostic studies, rapid reviews or living systematic reviews.…”

“…Historically, our evidence synthesis publications have mainly been simple systematic reviews of intervention trials or observational studies. [1][2][3][4][5][6][7][8][9] However, we published our journal's first individual participant data meta-analysis earlier this year 10 and are interested in receiving submissions of other more sophisticated approaches to evidence synthesis, including network meta-analyses, systematic reviews of prognostic or diagnostic studies, rapid reviews or living systematic reviews. We are also interested in receiving manuscripts that describe other types of meta-research work, for example, work identifying patterns of research prioritization, conduct, reporting and dissemination relevant to the field of allergy.…”

Improving asthma control and oral immunotherapy protocols

“…Increasing the dose of inhaled corticosteroids (ICS) may bring asthma under control during an exacerbation. Zhang et al have undertaken a systematic review and meta‐analysis to compare increased with stable doses of ICS . They used a standard approach searching three databases to 02 August 2018 and included only parallel group randomized clinical trials.…”