Association of Inhaled Corticosteroids and Long-Acting β-Agonists as Controller and Quick Relief Therapy With Exacerbations and Symptom Control in Persistent Asthma: A Systematic Review and Meta-analysis.

摘要: Importance Combined use of inhaled corticosteroids and long-acting β-agonists (LABAs) as the controller quick relief therapy termed single maintenance reliever (SMART) is a potential therapeutic regimen for management persistent asthma. Objective To conduct systematic review meta-analysis effects SMART in patients with Data Sources Study Selection The databases MEDLINE via OVID, EMBASE, Cochrane Central Register Controlled Trials, Database Systematic Reviews were searched from database inception through August 2016 updated November 28, 2017. Two reviewers selected randomized clinical trials or observational studies evaluating vs without LABA used short-acting aged 5 years older asthma reporting on an outcome interest. Extraction Synthesis Meta-analyses conducted using random-effects model to calculate risk ratios (RRs), differences (RDs), mean corresponding 95% CIs. Citation screening, data abstraction, assessment, strength evidence grading completed by 2 independent reviewers. Main Outcomes Measures Asthma exacerbations. Results analyses included 16 (N = 22 748 patients), 15 which evaluated combination budesonide formoterol dry-powder inhaler. Among 12 (n = 22 524; age, 42 years; 14 634 [65%] female), was associated reduced exacerbations compared same dose (RR, 0.68 [95% CI, 0.58 0.80]; RD, −6.4% −10.2% −2.6%]) higher 0.77 0.60 0.98]; −2.8% −5.2% −0.3%]). Similar results seen when alone therapy. 4 11 (n = 341; median 8 [range, 4-11] 69 [31%] 0.55 0.32 0.94]; −12.0% −22.5% −1.5%]) 0.38 0.23 0.63]; −23.2% −33.6% −12.1%]). Conclusions Relevance In this asthma, (with β-agonist) lower Evidence limited.