背景:SABA对症状的间歇性ICS治疗,是控制轻度至中度哮喘的新兴策略,和反复发作的喘息。这篇系统的评论比较了每日与每日的疗效。学龄前儿童的间歇性ICS,儿童和成人持续喘息和轻度至中度稳定持续哮喘。
方法:系统评价随机,每天最少8周的安慰剂对照试验(在恶化期间每天用救援SABA进行ICS)与间歇性ICS(症状发作时ICS加SABA),通过不同的数据库检索。主要结果是哮喘急性加重;次要结果是肺功能检查,症状,没有症状的日子,SABA使用,使用皮质类固醇,没有使用救护药物的日子,一氧化氮过期和严重不良事件。
结果:七项试验(1367名参与者)符合纳入标准,每日与每日相比,哮喘加重率无统计学差异间歇性ICS(0.96;95%CI:0.86,1.06,I(2)=0%)。在分组分析中,研究持续时间没有差异,升级策略或年龄。然而,与间歇性ICS相比,每日ICS组的无哮喘天数显著增加,而救援SABA使用和呼出一氧化氮测定无显著减少.
结论:在降低哮喘急性发作的发生率方面,每日和间歇性ICS没有显著差异。然而,日常ICS策略在许多次要结局方面均优于此.因此,这项研究表明,对于学龄前儿童的间歇性ICS使用,不要每天改变,儿童持续性喘息和成人轻度至中度稳定持续性哮喘。国际前瞻性系统评价登记册http://www。crd.约克。AC.英国/PROSPERO/(CRD42012003228)。
BACKGROUND: Intermittent ICS treatment with SABA in response to symptoms, is an emerging strategy for control of mild-to-moderate asthma, and recurrent wheezing. This systematic revue compares the efficacy of daily vs. intermittent ICS among preschoolers, children and adults with persistent wheezing and mild to moderate stable persistent asthma.
METHODS: Systematic
review of randomized, placebo-controlled trials with a minimum of 8 weeks of daily (daily ICS with rescue SABA during exacerbations) vs. intermittent ICS (ICS plus SABA at the onset of symptoms), were retrieved through different databases. Primary outcome was asthma exacerbations; secondary outcomes were pulmonary function tests, symptoms, days without symptoms, SABA use, corticosteroids use, days without rescue medication use, expired nitric oxide and serious adverse events.
RESULTS: Seven trials (1367 participants) met inclusion criteria there was no statistically significant difference in the rate of asthma exacerbations between those with daily vs. intermittent ICS (0.96; 95% CI: 0.86, 1.06, I(2) = 0%). In the sub-group analysis, no differences were seen in duration of studies, step-up strategy or age. However, compared to intermittent ICS, the daily ICS group had a significant increase in asthma-free days and non-significant decreases in rescue SABA use and exhaled nitric oxide measurement.
CONCLUSIONS: No significant differences between daily and intermittent ICS in reducing the incidence of asthma exacerbations was found. However, the daily ICS strategy was superior in many secondary outcomes. Therefore, this study suggests to not change daily for intermittent ICS use among preschoolers, children with persistent wheezing and adults with mild-to-moderate stable persistent asthma. International prospective register of systematic reviews http://www.crd.york.ac.uk/PROSPERO/ (CRD42012003228).