The quality of evidence is downgraded by study limitations (unclear blinding), by inconsistency (unexplained variability in results), and by imprecise results (wide confidence intervals).
A Cochrane review [Abstract] 1 included 8 studies with a total of 1470 adults and 470 children examining if the addition of a leukotriene receptor antagonist (LTRA) produces a beneficial effect in in children and adults with acute asthma who are currently receiving inhaled bronchodilators and systemic corticosteroids. For oral treatment, there was no significant difference in hospital admission between LTRAs and control (RR 0.86, 95% CI 0.21 to 3.52; 3 studies, 194 children). Using a broader composite outcome which measured requirement for additional care there was no significant difference between treatments (RR 0.87, 95% CI 0.60 to 1.28). Results demonstrated some indication of improvement in lung function with a significant difference in FEV1 favouring LTRAs (MD 0.08, 95% CI 0.01 to 0.14; 2 studies, 641 adults). There were insufficient data to assess this outcome in children. The most common adverse event described was headache; however, there was no significant difference between LTRAs and control (RR 0.81, 95% CI 0.22 to 2.99).
The combined results of 2 studies of intravenous treatment in 772 adults and 1 study in 276 children demonstrated a reduction in the risk of hospital admission which was not quite statistically significant (RR 0.78, 95% CI 0.61 to 1.01). There was a statistically significant small difference in FEV1 in the adult studies (MD 0.12, 95% CI 0.06 to 0.17), but not in the single trial in children (MD 0.01, 95% CI -0.06 to 0.08).
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