CQ1　Which is more effective for improved long-term management of bronchial asthma with inhaled corticosteroids (ICS) in pediatric patients, increasing the dose of ICS or addition of inhaled long-acting β₂ agonists to ICS (ICS/LABA) ?

Abstract

 Background : In children with bronchial asthma that is poorly controlled despite long-term inhaled corticosteroids (ICS), whether increased dose ICS is superior to or inferior to the addition of long-acting β₂ agonists (LABA) to ICS (denoted here as ICS/LABA) is unclear. Methods : Randomized controlled trials (RCTs) that involved pediatric patients with bronchial asthma and that were published prior to March 2016 were systematically reviewed. Acute exacerbations of asthma requiring use of oral corticosteroids served as a primary outcome measure, and acute exacerbations requiring hospital admission, visits to the emergency department, dropouts from trials, respiratory function, symptoms, use of short-acting β₂ agonists, and adverse events served as secondary outcome measures. Results : Eight RCTs were reviewed. Increased dose ICS and ICS/LABA did not differ significantly in terms of preventing acute exacerbations that required use of oral corticosteroids. Increased dose ICS and ICS/LABA did not differ significantly in terms of preventing acute asthma exacerbations requiring hospital admission, preventing visits to the emergency department, improving the Asthma Symptoms Score, or preventing adverse reactions. ICS/LABA resulted in better respiratory function and a greater percentage increase in height. Conclusion : At the current point in time, there is no clear indication whether increased dose ICS is superior to or inferior to ICS/LABA.