A Cochrane review [Abstract] 1 included 48 studies with a total of 15 155 subjects (1 155 children and 14 000 adults). Participants were inadequately controlled on their current inhaled corticosteroids (ICS) regimen. The combination of salmeterol or formoterol with a median dose of 400 mcg/day of beclomethasone or equivalent (BDP-eq) was compared to a median of 1000 mcg/day of BDP-eq, usually for 24 weeks or less.
Exacerbations requiring systemic corticosteroids in patients treated with long-acting inhaled ß2 agonist (LABA) and ICS were reduced (RR 0.88, 95% CI 0.78 to 0.98, 25 studies, N = 9 833) from 11.45% to 10% (NNT=73). There was no statistically significant difference in the risk for either hospital admission (RR 1.02, 95% CI 0.67 to 1.56) or serious adverse events (RR 1.12, 95% CI 0.91 to 1.37). The combination of LABA and ICS resulted in significantly greater but modest improvement from baseline in lung function, symptoms and rescue medication use than with higher ICS dose. Despite no significant group difference in the risk of overall adverse events (RR 0.99, 95% CI 0.95 to 1.03), there was an increase in the risk of tremor (RR 1.84, 95% CI 1.20 to 2.82) and a lower risk of oral thrush (RR 0.58, 95% CI 0.40 to 0.86) in the LABA and ICS compared to the higher ICS group. There was no significant difference in hoarseness or headache between the treatment groups. The rate of withdrawals due to poor asthma control favoured the combination of LABA and ICS (RR 0.65, 95% CI 0.51 to 0.83).
The following decision support rules contain links to this evidence summary:
Primary/Secondary Keywords