Long-acting beta2-agonists versus anti-leukotrienes as add-on therapy to inhaled corticosteroids for chronic asthma.

摘要: Background Patients who continue to experience asthma symptoms despite taking regular inhaled corticosteroids (ICS) represent a management challenge. Leukotriene receptor antagonists (LTRA) and long-acting beta(2)-agonists (LABA) agents may both be considered as add-on therapy (ICS). Objectives We compared the efficacy safety profile of adding either daily LABA or LTRA in asthmatic patients remained symptomatic on ICS. Search strategy The Cochrane Airways Group Specialised Register was searched for randomised controlled trials up including March 2006. Reference lists all included studies reviews were screened identify potentially relevant citations. Inquiries regarding other published unpublished supported by authors pharmaceutical companies manufacture these made. Conference proceedings major respiratory meetings also searched. Selection criteria Only conducted adults children with recurrent where (for example, salmeterol formoterol) montelukast, pranlukast, zafirlukast) added ICS minimum 28 days inclusion. Inhaled short-acting short courses oral steroids permitted rescue medications. Other treatments permitted, providing dose constant during intervention period. Two reviewers independently reviewed literature searches. Data collection analysis extraction trial quality assessment two reviewers. Whenever possible, primary study requested confirm methodology data provide additional information clarification when needed. Where necessary, expansion graphic reproductions estimation from presented paper performed. Main results Fifteen met inclusion criteria; eleven 6,030 participants provided sufficient detail permit aggregation. All pertained moderate airway obstruction (% predicted FEV(1) 66-76%) at baseline. Montelukast (n=9) Zafirlukast (n=2) Salmeterol Formoterol 400-565 mcg beclomethasone equivalent. Risk exacerbations requiring systemic significantly lower LABA+ICS LTRA+ICS (RR= 0.83, 95% Confidence Interval (95%CI): 0.71, 0.97): number needed treat LTRA, prevent one exacerbation over 48 weeks, 38 (95% CI: 23 247). following outcomes improved addition (Weighted Mean Difference; 95%CI): morning PEFR (16 L/min; 13 18), evening (12 9 15), (80 mL; 60 100), rescue-free (9%; 5% 13%), symptom-free (6%; 2 11), (-0.5 puffs/day; -0.2 -1), life (0.1; 0.05 0.2), symptom score (Standard Difference -0.2; -0.1 -0.3), night awakenings (-0.1/week; -0.06 -0.2) patient satisfaction (RR 1.12; 1.07 1.16). withdrawals due any reason (Risk Ratio CI 0.73 0.95). Withdrawals adverse events poor control, hospitalisation, osteopenia, serious events, overall headache cardiovascular not different between groups. Authors' conclusions In inadequately low doses steroids, is superior preventing improving lung function, symptoms, use beta(2)-agonists.