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Meta-Analysis
. 2005 Oct 19;2005(4):CD005076.
doi: 10.1002/14651858.CD005076.pub2.

Long-acting beta2-agonists as an inhaled corticosteroid-sparing agent for chronic asthma in adults and children

P G Gibson  1 , H Powell, F Ducharme
Affiliations
Meta-Analysis

Long-acting beta2-agonists as an inhaled corticosteroid-sparing agent for chronic asthma in adults and children

P G Gibson et al. Cochrane Database Syst Rev. .

Abstract

Background: The addition of a long acting beta agonist (LABA) to inhaled corticosteroid (ICS) therapy can improve asthma symptoms and reduce exacerbations. The addition of LABA may also have an ICS-sparing effect and permit a reduction in ICS maintenance dose.

Objectives: To determine the efficacy of adding LABA to maintenance ICS therapy in reducing the requirement for ICS while maintaining control of chronic asthma.

Search strategy: We searched the Cochrane Airways Group trials register and reference lists of articles. Date of last search: November 2004

Selection criteria: Parallel RCTs that compared reduced dose ICS in combination with LABA vs ICS alone in asthmatics requiring daily ICS.

Data collection and analysis: Trial quality was assessed and data were extracted independently by two reviewers. Study authors were contacted for confirmation. Trials were analysed according to the following ICS dose comparisons: a fixed moderate/high dose or a reduced/tapering dose of the same ICS.

Main results: 19 publications describing 10 trials of adults were included in the review. Studies that compared reduced dose (mean 60% reduction) ICS/LABA combination to a fixed moderate/high dose ICS found no significant difference in severe exacerbations requiring oral corticosteroids (RR 1.0, 95%CI 0.76 to 1.32), withdrawal due to worsening asthma (RR 0.82, 95%CI 0.5 to 1.35) or airway inflammation. There were also significant improvements in FEV1 (change from baseline WMD 0.10, 95%CI 0.07 to 0.12), morning & evening PEF and percent rescue free days with LABA. Two studies provided outcomes for a reduced/tapering ICS dose comparison. More participants receiving the LABA/reduced ICS combination achieved a reduction in ICS dose reaching significance in one study. A significant reduction of 253 mcg BDP was achieved in one study.

Authors' conclusions: In adults with asthma, using moderate to high maintenance doses of ICS, the addition of LABA has an ICS-sparing effect. The addition ofLABA permits more participants on minimum maintenance ICS to reduce ICS. The precise magnitude of the ICS dose reduction requires further study.

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Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS, Outcome 1 Severe exacerbation requiring OCS.
1.2
1.2. Analysis
Comparison 1 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS, Outcome 2 Withdrawal due to worsening asthma.
1.3
1.3. Analysis
Comparison 1 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS, Outcome 3 FEV1 (L) change from baseline.
1.4
1.4. Analysis
Comparison 1 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS, Outcome 4 FEV1 (percent predicted).
1.5
1.5. Analysis
Comparison 1 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS, Outcome 5 Morning PEF (L/min) change from baseline.
1.6
1.6. Analysis
Comparison 1 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS, Outcome 6 Evening PEF (L/min) change from baseline.
1.7
1.7. Analysis
Comparison 1 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS, Outcome 7 Rescue medications (puffs/day) change from baseline.
1.8
1.8. Analysis
Comparison 1 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS, Outcome 8 Percent Rescue Free Days change from baseline.
1.9
1.9. Analysis
Comparison 1 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS, Outcome 9 Percent Symptom Free Days.
1.10
1.10. Analysis
Comparison 1 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS, Outcome 10 Symptom Score change from baseline.
1.11
1.11. Analysis
Comparison 1 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS, Outcome 11 Night Waking change from baseline.
1.12
1.12. Analysis
Comparison 1 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS, Outcome 12 Adverse Events.
1.13
1.13. Analysis
Comparison 1 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS, Outcome 13 Overall Withdrawals.
2.1
2.1. Analysis
Comparison 2 LABA + reduced/tapering dose ICS vs reduced/tapering dose ICS, Outcome 1 FEV1 (L) change from baseline.
2.2
2.2. Analysis
Comparison 2 LABA + reduced/tapering dose ICS vs reduced/tapering dose ICS, Outcome 2 Morning PEF (L/min) change from baseline.
3.1
3.1. Analysis
Comparison 3 LABA + reduced/tapering dose ICS vs ICS alone (uncontrolled on < mod dose ICS), Outcome 1 Withdrawal due to worsening asthma.
3.2
3.2. Analysis
Comparison 3 LABA + reduced/tapering dose ICS vs ICS alone (uncontrolled on < mod dose ICS), Outcome 2 FEV1 (L) change from baseline.
3.3
3.3. Analysis
Comparison 3 LABA + reduced/tapering dose ICS vs ICS alone (uncontrolled on < mod dose ICS), Outcome 3 Morning PEF (L/min) change from baseline.
3.4
3.4. Analysis
Comparison 3 LABA + reduced/tapering dose ICS vs ICS alone (uncontrolled on < mod dose ICS), Outcome 4 Evening PEF (L/min) change from baseline.
3.5
3.5. Analysis
Comparison 3 LABA + reduced/tapering dose ICS vs ICS alone (uncontrolled on < mod dose ICS), Outcome 5 Rescue medications change from baseline.
3.6
3.6. Analysis
Comparison 3 LABA + reduced/tapering dose ICS vs ICS alone (uncontrolled on < mod dose ICS), Outcome 6 Percent Rescue Free Days change from baseline.
3.7
3.7. Analysis
Comparison 3 LABA + reduced/tapering dose ICS vs ICS alone (uncontrolled on < mod dose ICS), Outcome 7 Percent symptom free days change from baseline.
3.8
3.8. Analysis
Comparison 3 LABA + reduced/tapering dose ICS vs ICS alone (uncontrolled on < mod dose ICS), Outcome 8 Symptom Score change from baseline.
3.9
3.9. Analysis
Comparison 3 LABA + reduced/tapering dose ICS vs ICS alone (uncontrolled on < mod dose ICS), Outcome 9 Night Waking change from baseline.
3.10
3.10. Analysis
Comparison 3 LABA + reduced/tapering dose ICS vs ICS alone (uncontrolled on < mod dose ICS), Outcome 10 Adverse Events.
3.11
3.11. Analysis
Comparison 3 LABA + reduced/tapering dose ICS vs ICS alone (uncontrolled on < mod dose ICS), Outcome 11 Overall Withdrawals.
4.1
4.1. Analysis
Comparison 4 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS (asthma control), Outcome 1 Percent Rescue Free Days change from baseline.
4.2
4.2. Analysis
Comparison 4 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS (asthma control), Outcome 2 Percent Symptom Free Days change from baseline.
4.3
4.3. Analysis
Comparison 4 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS (asthma control), Outcome 3 Symptom Score change from baseline.
5.1
5.1. Analysis
Comparison 5 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS (device), Outcome 1 Percent Rescue Free Days change from baseline.
5.2
5.2. Analysis
Comparison 5 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS (device), Outcome 2 Percent Symptom Free Days change from baseline.
5.3
5.3. Analysis
Comparison 5 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS (device), Outcome 3 Symptom Score change from baseline.
6.1
6.1. Analysis
Comparison 6 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS (quality), Outcome 1 Percent Rescue Free Days change from baseline.
6.2
6.2. Analysis
Comparison 6 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS (quality), Outcome 2 Percent Symptom Free Days change from baseline.
6.3
6.3. Analysis
Comparison 6 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS (quality), Outcome 3 Symptom Score change from baseline.
7.1
7.1. Analysis
Comparison 7 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS (ICS/LABA), Outcome 1 Percent Rescue Free Days change from baseline.
7.2
7.2. Analysis
Comparison 7 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS (ICS/LABA), Outcome 2 Percent Symptom Free Days change from baseline.
7.3
7.3. Analysis
Comparison 7 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS (ICS/LABA), Outcome 3 Symptom Score change from baseline.
8.1
8.1. Analysis
Comparison 8 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS (duration), Outcome 1 Percent Rescue Free Days change from baseline.
8.2
8.2. Analysis
Comparison 8 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS (duration), Outcome 2 Percent Symptom Free Days change from baseline.
8.3
8.3. Analysis
Comparison 8 LABA + reduced/tapering dose ICS vs fixed mod/high dose ICS (duration), Outcome 3 Symptom Score change from baseline.
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Update of

References

References to studies included in this review

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Aziz 2000 {published data only}
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Kavuru 2000 {published data only}
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Matz 2001 {published data only}
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McIvor 1998 {published data only}
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Miraglia del Giudice {published data only}
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Ortega‐Cisneros 1998 {published data only}
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Ozkaya 1999 {published data only}
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Price 2002 {published data only}
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Shapiro 2000 {published data only}
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Stojkovic‐Andjelkovi {published data only}
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Tal 2002 {published data only}
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Weinstein 2001 {published data only}
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Zetterstrom 2001 {published data only}
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