Is There Any Point in a Corticosteroid Treatment of Intermittent Asthma?

Stanković, Ivana; Pejčić, Tatjana; Milenković, Branislava; Jovanović, Dragana; Rančić, Milan

doi:10.1100/tsw.2007.134

Cited by 6 publications

(11 citation statements)

References 19 publications

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“…In a recent study, 96 mild intermittent asthma patients were randomly allocated to either treatment with SABA monotherapy or in addition with low dose ICS (beclomethasone diproprionate 250 μg/day) 8. After 6 months, the SABA and ICS therapy showed a statistically significant improvement in FEV 1 (3.58 L versus 3.66 L) as well as improvements in FVC, FEV 1 /FVC, and PEF.…”

Section: Mild Intermittent Asthmamentioning

confidence: 99%

Current recommendations for the treatment of mild asthma

Shahidi¹,

FitzGerald²

2010

JAA

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Patients suffering from mild asthma are divided into intermittent or persistent classes based on frequency of symptoms and reliever medication usage. Although these terms are used as descriptors, it is important to recognize the approach of focusing on asthma control in managing asthma patients. Beta-agonists are considered first-line therapy for intermittent asthmatics. If frequent use of beta-agonists occurs more than twice a week, controller therapy should be considered. For persistent asthma, low-dose inhaled corticosteroids are recommended in addition to reliever medication. Compliance to regular therapy can pose problems for disease management, and while intermittent controller therapy regimens have been shown to be effective, it is imperative to stress the value of regular therapy especially if an exacerbation occurs. It is also important when such an approach is adopted that there is regular re-evaluations of asthma control. This is because regular anti-inflammatory therapy may become necessary if symptoms become more persistent. Other therapies are seldom needed. Antileukotrienes can be considered an option for mild asthma; however, studies have shown that they are not as effective as inhaled corticosteroids. Aside from therapy, patient education, which includes a written action plan, should be a component of the patient’s strategy for disease management.

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Section: Mild Intermittent Asthmamentioning

confidence: 99%

Current recommendations for the treatment of mild asthma

Shahidi¹,

FitzGerald²

2010

JAA

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“…The overall effect of ICS on FEV1 change was also significant when compared with the effect of placebo (8 studies; SMD, 0.51; 95% CI, 0.22 to 0.80; I 2 =49%; Fig. 2A ) ( 10 , 11 , 13 – 17 , 22 ).…”

Section: Resultsmentioning

confidence: 92%

“…After 6 months of treatment, a further reduction of PEF variability was noted ( 22 ) (1 study; WMD, −4.57%; 95% CI, −4.92 to −4.22%). The overall effect of ICS treatment vs. placebo was also significant in PEF variability ( 10 , 21 , 22 ) (3 studies; WMD, −3.58%; 95% CI, −5.75 to −1.41%; I 2 =78%; Fig. 3A ).…”

Section: Resultsmentioning

confidence: 99%

“…2A) (14,16,22). Consistent with the results observed after 3–6 months of treatment, after 1 year of treatment, a further improvement in FEV1 was noted in the ICS groups as compared with placebo (2 studies; SMD, 0.86; 95% CI, 0.34 to 1.39; I 2 =15%; Fig.…”

Section: Resultsmentioning

confidence: 99%

“…3B) (11,22). The overall effect was not significant (2 studies; WMD, 1.44%; 95% CI, −1.38 to 4.26; I 2 =69%; Fig.…”

Section: Resultsmentioning

confidence: 99%

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Inhaled corticosteroids improve lung function, airway hyper-responsiveness and airway inflammation but not symptom control in patients with mild intermittent asthma: A meta-analysis

Zhou

et al. 2017

Experimental and Therapeutic Medicine

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It remains controversial whether inhaled corticosteroid (ICS) should be used in patients with intermittent asthma. The present study aimed to assess the effect of ICS compared with placebo or other therapies in patients with intermittent asthma. Medline, Embase and CNKI databases were searched up to June 2016 and a meta-analysis was conducted. The findings demonstrated that in adult patients, when compared with placebo, ICS increased forced expiratory volume in 1 sec FEV1 [standardized mean difference (SMD), 0.51; 95% confidence interval (CI), 0.22–0.80] and alleviated airway hyper-responsiveness, which was indicated as log transformed PC20FEV1 (concentrations of methacholine when there was a fall in FEV1 ≥20%; SMD, 0.87; 95% CI, 0.60 to 1.14). ICS also reduced fractional exhaled nitric oxide (FeNO) levels [weighted mean difference (WMD), −12.57 parts per billion (ppb; a unit of NO concentration in exhaled air); 95% CI −15.88 to −9.25 ppb]. However, symptom scores did not change after ICS treatment (SMD, −0.26; 95% CI, −0.52 to 0). When compared with leukotriene receptor antagonists (LTRA), ICS had no advantage in increasing FEV1 (WMD, 0.04 l; 95% CI, −0.06 to 0.13 l), reducing sputum eosinophil percentage (WMD, −6%; 95% CI, −12.38 to 0.38%) or symptom scores (SMD, 0.44; 95% CI, −0.02 to 0.9). However, in child patients, ICS significantly (P<0.05) increased the possibility of symptom control when compared with placebo [relative risk (RR), 8; 95% CI, 1.04 to 61.52] or LTRA (RR, 2.67; 95% CI, 0.39 to 18.42). In conclusion, ICS improves lung function and alleviates airway hyper-responsiveness and airway inflammation but cannot influence symptom scores, and has no advantage over LTRA in terms of lung function improvement and airway inflammation control in adult patients with mild intermittent asthma. However, in children, the benefit of ICS in symptom control is more significant than with LTRA.

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