Cochrane for Clinicians
Putting Evidence into Practice
Intermittent Inhaled Corticosteroid Therapy for Mild Persistent Asthma in Children and Adults
Am Fam Physician. 2016 Jul 1;94(1):21-22.
Is the use of intermittent inhaled corticosteroid therapy safe and effective for mild persistent asthma in children and adults?
Intermittent inhaled corticosteroid therapy reduces the risk of asthma exacerbations in children and adults with mild persistent asthma. Intermittent use appears to be safe in these patients. (Strength of Recommendation: B, based on limited-quality evidence from randomized controlled trials.)
Asthma accounts for 14.2 million office visits to U.S. physicians (1.4% of all encounters) each year and is responsible for significant respiratory-associated morbidity and mortality.1 Symptoms such as wheezing, cough, and dyspnea can vary in timing and intensity. Clinical management includes quantifying asthma severity and providing patient education, environmental control, and stepwise treatment with medications, if required.2 Daily inhaled corticosteroid therapy for children and adults is recognized as standard treatment for persistent asthma.2 However, for patients with mild persistent asthma symptoms, optimal inhaled corticosteroid use has not been determined. This Cochrane review studied whether intermittent inhaled corticosteroids initiated at the time of an exacerbation could safely manage mild persistent asthma in children and adults without the need for oral corticosteroids.
The Cochrane review included six double-blind, placebo-controlled, randomized trials enrolling 490 preschool-aged children up to five years of age, 145 school-aged children, and 240 adults. In all trials, intermittent inhaled corticosteroid therapy was compared with placebo, and rescue inhalers and oral corticosteroids were the only cointerventions allowed during exacerbations. The protocols for how to use intermittent inhaled corticosteroid therapy varied, but usually involved taking inhaled corticosteroids with a bronchodilator as needed to relieve symptoms. Preschool-aged children with suspected asthma symptoms were a
1. Centers for Disease Control and Prevention. National Ambulatory Medical Care Survey: 2010 summary tables. http://www.cdc.gov/nchs/data/ahcd/namcs_summary/2010_namcs_web_tables.pdf. Accessed September 15, 2015.
2. National Asthma Education and Prevention Program Expert Panel Report 3. Guidelines for the diagnosis and management of asthma: summary report 2007. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/files/docs/guidelines/asthsumm.pdf. Accessed September 11, 2015.
3. Chauhan BF, Chartrand C, Ducharme FM. Intermittent versus daily inhaled corticosteroids for persistent asthma in children and adults. Cochrane Database Syst Rev. 2013;(2):CD009611.
These are summaries of reviews from the Cochrane Library.
This series is coordinated by Corey D. Fogleman, MD, Assistant Medical Editor.
A collection of Cochrane for Clinicians published in AFP is available at http://www.aafp.org/afp/cochrane.
Copyright © 2016 by the American Academy of Family Physicians.
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