A Cochrane review [Abstract] 1 included 36 studies on xanthines in the maintenance treatment of paediatric asthma, with a total of 2 838 subjects. In all studies the active intervention was an oral xanthine: in all but the oldest studies this was theophylline. Compared with placebo, the proportion of symptom free days was larger with xanthine (7.97%; 95% CI 3.41 to 12.53; 17 studies). FEV1 and PEF were better and rescue medication usage was lower with xanthine, with no significant difference in symptom scores or hospitalisations.
Compared with inhaled corticosteroids (4 studies), exacerbations were more frequent with xanthines, but no significant difference on lung function was observed. Individual studies reported significant improvements in symptom measures in favour of steroids, and one study reported a difference in growth rate in favour of xanthine. Compared with regular short-acting beta-agonists (10 studies), there was no significant difference in symptoms, rescue medication usage and spirometry. Individual studies reported improvement in PEF with beta-agonist. Beta-agonist treatment led to fewer hospitalisations and headaches. Compared with cromoglycate (6 studies), there was no significant difference in symptoms, exacerbations and rescue medication. The only study comparing Xanthine with leukotriene antagonist as add on to inhaled corticosteroids did not measure the primary outcome of symptoms; differences between treatments in end of treatment values were not statistically significant.
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