A Cochrane review [Abstract] 1 included 12 studies. Three trials (n=909) comparing inhaled corticosteroids (ICS) with oral corticosteroids to oral corticosteroids (CS) alone showed no significant benefit from adding ICS to CS. Relapses were reduced, but not significantly (OR 0.68, 95% CI 0.46 to 1.02). No differences were observed between the two groups for relapses requiring admission, quality of life, symptom scores, or adverse effects. Nine trials, involving a total of 1296 patients, compared ICS alone to CS alone. Results showed no differences for relapse rates (OR 1.00, 95% CI 0.66 to 1.52). However, severe asthmatics were excluded from these trials. The results on ICS + CS Vs ICS alone do not apply to young children, since none of the studies involved patients from this age group.
Comment: The quality of evidence is downgraded by sparse data and indirectness (most asthmatics are continuously on inhaled steroids, so that inhaled steroids are always part of their medication).
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