asthma
DISEASE INTERVENTION COMPARISON RESULTS
N Engl J Med. 2018 Mar 08;378(10):902-910 Randomized Controlled Trial, Multicenter Study
IN asthma, acute exacerbation The Use of
self-management plan including a temporary quadrupling of the dose of inhaled glucocorticoids when asthma control start to deteriorate
As Treatment, Acute
Is better Than
self-management plan without increase of inhaled corticosteroids
To reduce severe asthma exacerbations at 1 year: 45% with quadrupling VS 52% in the non-quadrupling. More local adverse events with quadrupling.
N Engl J Med. 1998 Oct 22;339(17):1194-200 Cohorts
IN asthma The Use of
natural history, follow-up of ventilatory function, FEV1
As Prognostic Item
Is useful Than
-
To Among both men and women, smokers and nonsmokers, subjects with asthma had greater declines in FEV1 over time (38 ml per year) than those without asthma (22 ml per year)
N Engl J Med. 2007 May 17;356(20):2040-52 Randomized Controlled Trial, Multicenter Study
IN asthma The Use of
combination of inhaled corticosteroids and long-acting beta2-agonists (beclomethasone, albuterol) as on-demand reliever Tt
As Treatment, Chronic
Is better Than
only short-acting b2-agonists on-demand
To reduce at 6 months number of exacerbations (numbers not stated in abstract). But it was NOT better than regular inhaled corticoids plus on-demand or than regular combined treatment
Am J Respir Crit Care Med. 2005 Jan 15;171(2):129-36 Randomized Controlled Trial
IN asthma The Use of
combination of inhaled corticosteroids and long-acting beta2-agonists (budesonide, formoterol) as on-demand reliever Tt
As Treatment, Chronic
Is better Than
inhaled short-acting beta2-agonist as on-demand reliever Tt
To lower exacerbation risk (hazard ratio, 0.55), prolonged the time to the first exacerbation requiring medical intervention and improve symptoms.
Chest. 1999 Sept;116(3):595-602 Randomized Controlled Trial
IN asthma The Use of
inhaled beta2 agonist, long-term fixed regular use
As Treatment, Chronic
Is better Than
placebo and inhaled beta2 agonist, as needed
To improving FEV1 and symptoms. No differences in the annual rate, timing, or duration of exacerbations.
Lancet. 2000 May 13;355(9216):1675-79 Randomized Controlled Trial
IN asthma The Use of
inhaled beta2 agonist, long-term fixed regular use
As Treatment, Chronic
Is better Than
placebo and inhaled beta2 agonist, as needed
To improving diurnal peak expiratory flow. No differences in the annual rate, timing, or duration of exacerbations.
Am J Med. 2010 Apr;123(4):322-8.e2 Meta-Analysis
IN asthma The Use of
inhaled long-acting beta2 agonist, long-term regular use
As Treatment, Chronic
Is worse Than
placebo or inhaled corticosteroids alone
To prevent asthma-related intubation or death: they increase the risk by 2 folds OR 2.10
Ann Intern Med. 2006 Jun 20;144(12):904-12. Epub 2006 Jun 5 Meta-Analysis
IN asthma The Use of
inhaled long-acting beta2-agonists
As Treatment, Chronic
Is worse Than
placebo
To prevent exacerbations: they increased hospitalisations by asthma exacerbation (OR, 2.6; absolute increase 0.7%) and life-threatening exacerbations (OR, 1.8)
Chest. 2006 Jan;129(1):15-26 Randomized Controlled Trial, Multicenter Study
IN asthma The Use of
inhaled short-acting beta2-agonist (salmeterol) as on-demand reliever Tt, added to usual treatment
As Treatment, Chronic
Is worse Than
placebo
To reduce, at 28 weeks, respiratory-related deaths (0.2% salbutamol VS 0.1% placebo)
Ann Intern Med. 2015 Sep 22; doi: 10.7326/M15-1059 [Epub ahead of print] Systematic Review
IN asthma The Use of
leukotriene antagonists
As Treatment, Chronic
Is better Than
placebo
To reduce the risk of exacerbations (RR 0.60) and increase FEV1. In 4 trials employed as add-on therapy to inhaled corticosteroids, the RR for exacerbation was 0.80 (CI, 0.60 to 1.07)
Am J Respir Crit Care Med. 2005 Jun 1;171(11):1231-6 Randomized Controlled Trial
IN asthma, acute exacerbation The Use of
corticosteroids, inhaled, fluticasone
As Treatment, Acute
Is better Than
parenteral IV corticosteroids
To improve PEF and FEV1 (30 to 46% more improvement with inhaled VS. IV corticosteroids) and reduce hospital admisions - all at 3 hours (very short term)
JAMA. 1999 Jun 9;281(22):2119-26 Randomized Controlled Trial
IN asthma, acute exacerbation The Use of
corticosteroids, inhaled, high dose, budesonide
As Treatment, Acute
Is better Than
placebo
To reducing symptoms and relapses, as unscheduled visits to physician, but not overall low rate of hospitalization. Improving quality of life.
BMJ. 1998 Oct 10;317:971-977 Meta-Analysis
IN asthma, acute exacerbation The Use of
inhaled anticholinergics added to inhaled beta-agonists
As Treatment, Acute
Is better Than
inhaled beta-agonists alone
To reduce the risk of hospital admission by 30% (RR 0.72, NNT 11) in children and adolescents with severe exacerbations
Am J Med. 1999 Oct;107:363-70 Meta-Analysis
IN asthma, acute exacerbation The Use of
inhaled anticholinergics added to inhaled beta-agonists
As Treatment, Acute
Is better Than
inhaled beta-agonists alone
To reducing hospitalization rate
N Engl J Med. 2012 Sep 2. [Epub ahead of print] Randomized Controlled Trial, Multicenter Study
IN asthma, persistent despite treatment with inhaled glucocorticoids and long-acting beta-agonists The Use of
inhaled long-acting anticholinergics, tiotropium
As Treatment, Chronic
Is better Than
placebo
To increase time to the first severe exacerbation (282 days vs. 226 days), and reduce risk of severe exacerbation (HR, 0.79). No deaths. Patients with cardiac disease were excluded: safety of tiotropium there?
N Engl J Med. 2005 Apr 14;352(15):1519-28 Randomized Controlled Trial
IN asthma, persistent, mild The Use of
as-needed corticosteroids, intermittent short-courses of inhaled or oral corticosteroids
As Treatment, Chronic
Is equal Than
as-needed inhaled corticoisteroids added to either daily inhaled corticosteroids or oral zafirlukast
To improve rate of asthma exacerbations or quality of life, taking much lesser doses of corticosteroids
Cochrane Database Syst Rev. 2013;2:CD009611 Systematic Review, Cochrane Review
IN asthma, persistent, mild The Use of
intermitent, as needed inhaled corticosteroids
As Treatment, Chronic
Is equal Than
daily inhaled corticosteroids, continuous
To modify the number of exacerbations, adverse effects, hospitalisations, emergency department visits or quality of life. In children, daily corticosteroid were associated with some lesser growth
N Engl J Med. 2011 May 5;364(18):1695-707 Randomized Controlled Trial
IN asthma, persistent, mild The Use of
leukotriene antagonists
As Treatment, Chronic
Is equal Than
inhaled glucocorticoid for first-line asthma-controller therapy, or a long-acting beta(2)-agonist as add-on therapy
To improve asthma-related quality of life at 2 months (MiniAQLQ score improvement of about 1 point) but not at 2 years (-0.11 points for leukotriene antag).
N Engl J Med. 2007 May 17;356(20):2027-39 Randomized Controlled Trial, Multicenter Study
IN asthma, persistent, mild The Use of
once daily inhaled corticosteroids
As Treatment, Chronic
Is better Than
leukotriene antagonist, once daily monlelukast
To reduce, at 4 months, treatment failure (20% inhaled corticoids VS 30% montelukast)
N Engl J Med. 2016 Sep;375(9):850-860 Randomized Controlled Trial, Multicenter Study
IN asthma, persistent, moderate to severe The Use of
long-acting beta(2)-agonists, formoterol added to inhaled corticoisteroids, budesonide
As Treatment, Chronic
Is better Than
inhaled corticoisteroids, budesonide alone
To reduce the number of exacerbations (HR 0.8) while not modifying the number of serious asthma-related events (<1%)
JAMA. 2013 Mar 27;309(12):1278-88 Systematic Review
IN asthma, rhinoconjunctivitis, allergic The Use of
sublingual immunotherapy
As Treatment, Chronic
Is better Than
placebo
To improves asthma symptoms (8 of 13 studies reported > 40% improvement)
Chest. 1998 Nov;114(5):349-1356 Clinical Trial (non-controlled, non-randomized)
IN asthma, severe, steroid dependent The Use of
IV immunoglobulin
As Treatment, Chronic
Is useful Than
no control
To reducing oral steroid requirements and steroid side effects
Lancet. 2004 Oct 23;364(9444):1505-12 Randomized Controlled Trial, Multicenter Study
IN asthma, treatment resistance The Use of
a genetic polymorphism of the beta2-adrenergic receptor (Arg/Arg homocygote at residue 16)
As Prognostic Item
Is useful Than
-
To induce resistence to or inversion of the bronchodilator effects of inhaled beta-2 agonists.