Cochrane Panel: Corticosteroids Achieve Best Asthma Control
Inhaled corticosteroids are better than sodium cromoglycate in measures of lung function and asthma control in children and adults with chronic asthma, the first-ever systematic review of its kind has concluded.
“The results suggest that the superiority of ICS over SCG may be independent of asthma severity, since results were generally similar among those with milder and more severe asthma,” wrote the researchers, who were led by Dr. James P. Guevara of the department of pediatrics at the University of Pennsylvania, Philadelphia. The superiority of ICS over SCG may depend on the dosage of inhaled steroid, since results in favor of ICS were generally stronger among studies with moderate doses than among those with low doses.
However, no conclusions could be made about possible differences in adverse events between ICS and SCG because adverse events in the trials chosen for analysis “were reported inconsistently, and most trials were short-term,” they noted.
The researchers reviewed 25 randomized, controlled trials that compared the effects of ICS with those of SCG in children and adults with chronic asthma. Of the 25 trials, 17 included 1,279 children and 8 included 321 adults (Cochrane Database System. Rev. 2006; DOI:10.1002/14651858.CD003558.pub2).
In the trials of children, use of ICS was associated with a higher mean forced expiratory volume in 1 second (FEV1) (a mean weighted difference of 0.07 L) and a higher final end-point peak expiratory flow (PEF) rate (a mean weighted difference of 17.3 L/minute), compared with use of SCG. Use of ICS was also associated with fewer exacerbations (a mean weighted difference of −1.18 per patient year), lower asthma symptom scores, and less bronchodilator use, compared with use of SCG.
In the trials of adults, use of ICS was associated with a higher mean FEV1 (a mean weighted difference of 0.21 L) and a higher final end-point PEF rate (a mean weighted difference of 28.2 L/minute), compared with use of SCG. Use of ICS also was associated with fewer exacerbations (a mean weighted difference of −3.30 per patient year) and less bronchodilator use, compared with use of SCG. Use of ICS was associated with lower asthma symptom scores than was SCG in the three crossover trials reviewed as part of the analysis, but not in the one parallel group trial reviewed.
