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Strategies for Preventing Asthma Exacerbations

Summary and Comment |
June 12, 2014

Strategies for Preventing Asthma Exacerbations

  1. Paul S. Mueller, MD, MPH, FACP

Only strategies involving inhaled corticosteroids plus long-acting β-agonists combined in a single inhaler outperformed monotherapy with low-dose ICSs.

  1. Paul S. Mueller, MD, MPH, FACP

In this systematic review and meta-analysis, investigators conducted a standardized comparison of the effectiveness and safety of various drug maintenance strategies for preventing asthma exacerbations. They evaluated 66 trials (60,000 patient-years of follow-up) in which results of 15 strategies (monotherapy with short- or long-acting β-agonists, leukotriene-receptor antagonists, or low- or high-dose inhaled corticosteroids [ICSs]; or various combination therapies) were reported. Participants were adults with asthma who were randomized to maintenance treatment of at least 24 weeks' duration.

Low-dose ICSs were superior to placebo and all other single-agent strategies for preventing severe exacerbations (i.e., prescription for systemic corticosteroids for ≥3 days, emergency department visit, or hospitalization). Only combinations of ICSs plus long-acting β-agonists lowered risk for severe exacerbations significantly better than low-dose ICS monotherapy (by about 50%). All other strategies that combined ICSs and other agents were not significantly better than low-dose ICSs. Similar results were found when a composite of severe and moderate exacerbations was considered.

Comment

In this extensive meta-analysis, low-dose ICS monotherapy was superior to all other single-agent strategies for preventing asthma exacerbations, and only ICSs combined with long-acting β-agonists lowered risk for severe exacerbations better than low-dose ICS monotherapy. These results affirm the central role of ICSs in managing patients with asthma and are consistent with current NIH guidelines.

  • Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication Consultant / advisory board Boston Scientific (Patient Safety Advisory Board) Leadership positions in professional societies American Osler Society (Vice President)

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Reader Comments (3)

Luis Filos Physician, Internal Medicine, Community and teaching hospital

This is a usefull information.

TM Chen, MD Physician, Pulmonary Medicine, hospital

The result is applicable to most cases but not every case of asthma.
Clinical indivisulization is still necessary. Thanks.

MUTASIM OMARA Physician, Endocrinology, Saudi Arabia

I do agree

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