Authors' objectives:

Asthma affects over 14 million persons in the U.S. and is the most common chronic disease of childhood. This systematic review addresses 5 key questions: (1) whether chronic use of inhaled corticosteroids (ICS) improves long-term outcomes for children with mild to moderate asthma; and whether chronic ICS use in children results in long-term adverse effects; (2) whether, for patients with mild-moderate asthma, early initiation of ICS prevents asthma progression; (3) whether, in patients with moderate asthma, adding other long-term controllers to low-moderate dosages of ICS improves control; (4) whether adding antibiotics to standard care improves the treatment of acute asthma exacerbation; and (5) whether a written asthma action plan improves outcomes; and whether a peak flow monitor-based plan is superior to a symptom-based plan.

Authors' results and conclusions: Compared to as-needed beta-2 agonists, ICS improves control in children with mild-to-moderate asthma; no alternative long-term controller appears to be superior. ICS therapy at recommended doses does not appear to have frequent, clinically significant, or irreversible effects on vertical growth, bone mineral density, ocular toxicity, or suppression of adrenal/pituitary axis in the short term. However, no studies have sufficient followup or size to assess cumulative effects in later life. The best available evidence does not support the hypothesis that mild to moderate asthmatics undergo progressive decline in lung function, which might be prevented by early ICS initiation. Adding long-acting beta-2 agonists or leukotriene antagonists to ICS improves asthma control, as may theophylline, but studies in children are lacking. The evidence suggests no benefit to using antibiotics routinely for treatment of acute asthma exacerbation. The evidence is insufficient to demonstrate that use of a written asthma action plan improves outcomes, or that peak flow monitoring-based plans are superior.

Authors' recommendations: A national research agenda for long-term studies to improve effectiveness of asthma management is needed, with high priority to pediatric studies. Future asthma trials should use common definitions for severity, population characteristics, and outcome measures and should comply with recognized standards for reporting and statistical analysis. Research on rational antibiotic use should include explicit study questions and populations relevant to asthma management.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.ahrq.gov/clinic/epcix.htm

Year Published: 2001

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: Agency for Healthcare Research and Quality

Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;

Contact Name: martin.erlichman@ahrq.hhs.gov

Contact Email: martin.erlichman@ahrq.hhs.gov

Copyright: Agency for Healthcare Research and Quality (AHRQ)