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Intermittent versus daily inhaled corticosteroids for persistent asthma in children and adults

  1. Bhupendrasinh F Chauhan1,
  2. Caroline Chartrand2,
  3. Francine M Ducharme3,4,*

Editorial Group: Cochrane Airways Group

Published Online: 28 FEB 2013

Assessed as up-to-date: 18 OCT 2012

DOI: 10.1002/14651858.CD009611.pub3


How to Cite

Chauhan BF, Chartrand C, Ducharme FM. Intermittent versus daily inhaled corticosteroids for persistent asthma in children and adults. Cochrane Database of Systematic Reviews 2013, Issue 2. Art. No.: CD009611. DOI: 10.1002/14651858.CD009611.pub3.

Author Information

  1. 1

    Research Centre, CHU Sainte-Justine, Clinical Research Unit on Childhood Asthma, Montreal, Canada

  2. 2

    CHU Sainte-Justine Hospital, Department of Pediatrics, Montreal, Canada

  3. 3

    University of Montreal, Department of Paediatrics, Montreal, Québec, Canada

  4. 4

    CHU Sainte-Justine, Research Centre, Montreal, Canada

*Francine M Ducharme, francine.m.ducharme@umontreal.ca.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions), comment added to review
  2. Published Online: 28 FEB 2013

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[Figure 1]
Figure 1. Study flow diagram.
[Figure 2]
Figure 2. Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
[Figure 3]
Figure 3. Forest plot of comparison: 1 Intermittent 'as needed' ICS versus daily ICS, outcome: 1.1 Patients with 1 or more exacerbations requiring oral corticosteroids.
[Figure 4]
Figure 4. Funnel plot of comparison: 1 Intermittent 'as needed' ICS versus daily ICS, outcome: 1.1 Patients with 1 or more exacerbations requiring oral corticosteroids.
[Figure 5]
Figure 5. Forest plot of comparison: 1 Intermittent 'as needed' ICS versus daily ICS, outcome: 1.2 Patients with serious adverse health events.
[Analysis 1.1]
Analysis 1.1. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 1 Patients with 1 or more exacerbations requiring oral corticosteroids.
[Analysis 1.2]
Analysis 1.2. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 2 Exacerbations requiring oral corticosteroids: subgroup analysis for age.
[Analysis 1.3]
Analysis 1.3. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 3 Exacerbations requiring oral corticosteroids: subgroup analysis for duration of treatment.
[Analysis 1.4]
Analysis 1.4. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 4 Exacerbations requiring oral corticosteroids: subgroup analysis for severity of airway obstruction.
[Analysis 1.5]
Analysis 1.5. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 5 Patients with serious adverse health events.
[Analysis 1.6]
Analysis 1.6. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 6 Patients with at least 1 exacerbation requiring emergency department/acute care visit.
[Analysis 1.7]
Analysis 1.7. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 7 Patients with at least 1 exacerbation requiring hospital admission.
[Analysis 1.8]
Analysis 1.8. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 8 Number of exacerbations requiring emergency department visits.
[Analysis 1.9]
Analysis 1.9. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 9 Time to exacerbation requiring oral corticosteroids.
[Analysis 1.10]
Analysis 1.10. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 10 Change from baseline AM PEFR (%).
[Analysis 1.11]
Analysis 1.11. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 11 Change from baseline AM PEFR (L/min).
[Analysis 1.12]
Analysis 1.12. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 12 Change from baseline FEV1 (%).
[Analysis 1.13]
Analysis 1.13. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 13 Change from baseline FEV1 (L).
[Analysis 1.14]
Analysis 1.14. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 14 Change from baseline mean diurnal variation in PEFR.
[Analysis 1.15]
Analysis 1.15. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 15 Change in PC20.
[Analysis 1.16]
Analysis 1.16. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 16 Change from baseline in asthma control days.
[Analysis 1.17]
Analysis 1.17. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 17 Proportion of asthma control days over the period.
[Analysis 1.18]
Analysis 1.18. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 18 Change from baseline mean daily use of β2-agonists (puffs/day).
[Analysis 1.19]
Analysis 1.19. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 19 Cumulative dose of rescue albuterol (μg) over the period.
[Analysis 1.20]
Analysis 1.20. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 20 Change from baseline in daytime symptom scores.
[Analysis 1.21]
Analysis 1.21. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 21 Change from baseline in asthma symptoms utility index.
[Analysis 1.22]
Analysis 1.22. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 22 Change in proportion of 'symptom-free days'.
[Analysis 1.23]
Analysis 1.23. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 23 Change from baseline in night-time awakenings.
[Analysis 1.24]
Analysis 1.24. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 24 Change from baseline in quality of life (QoL).
[Analysis 1.25]
Analysis 1.25. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 25 Days with use of β2-agonists (%).
[Analysis 1.26]
Analysis 1.26. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 26 Change in exhaled nitric oxide (ppb).
[Analysis 1.27]
Analysis 1.27. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 27 Change in height (cm).
[Analysis 1.28]
Analysis 1.28. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 28 Change in height (Z-score).
[Analysis 1.29]
Analysis 1.29. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 29 Change in weight (Z-score).
[Analysis 1.30]
Analysis 1.30. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 30 Change in weight (kg).
[Analysis 1.31]
Analysis 1.31. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 31 Salivary cortisol level.
[Analysis 1.32]
Analysis 1.32. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 32 Overall withdrawals.
[Analysis 1.33]
Analysis 1.33. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 33 Oral candidiasis.
[Analysis 1.34]
Analysis 1.34. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 34 Withdrawal owing to adverse events.
[Analysis 1.35]
Analysis 1.35. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 35 Cumulative dose of ICS over the period (μg beclomethasone equivalent).
[Analysis 1.36]
Analysis 1.36. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 36 Overall adverse effects.
[Analysis 1.37]
Analysis 1.37. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 37 Withdrawal owing to poor asthma control/exacerbations.
[Analysis 1.38]
Analysis 1.38. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 38 Pneumonia.
[Analysis 1.39]
Analysis 1.39. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 39 Nausea.
[Analysis 1.40]
Analysis 1.40. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 40 Headache.
[Analysis 1.41]
Analysis 1.41. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 41 Upper respiratory tract infections.
[Analysis 1.42]
Analysis 1.42. Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 42 Death.