Efficacy of inhaled corticosteroids for patients with asthma: a descriptive review of randomized controlled trials
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Publié-e :
mai 22, 2015
Mots-clés :
Asthma, sputum eosinophils, inhaled corticosteroids, chronic disease management,
Contenu principal de l'article
Résumé
Objective: To evaluate the efficacy of inhaled corticosteroids (ICS) in patients with asthma based on changes in sputum eosinophil counts, through a review of relevant randomized controlled trials (RCTs).
Methods: Studies were retrieved from MEDLINE, EMBASE, the SYSTEM FOR INFORMATION ON GREY LITERATURE, and the INSTITUTE FOR SCIENTIFIC INFORMATION from February 1, 2003 to February 1, 2013 based on a comprehensive search strategy. Articles were screened through two stages: title and abstract; and full-text screening. RCTs enrolling patients with asthma, testing an ICS intervention, and reporting outcomes on changes in sputum eosinophil counts pre- and post-intervention were included. Following screening, data extraction, and quality appraisal, a descriptive synthesis of trials was conducted.
Results: The search strategy retrieved 447 articles, of which 66 articles underwent full-text screening, resulting in 37 RCTs that met the inclusion criteria for this review. The articles were stratified according to the type of ICS: budesonide, fluticasone propionate, ciclesonide, beclomethasone dipropionate, and mometasone. Across trials, 9 of 16 budesonide, 5 of 14 fluticasone propionate, 4 of 9 of nine ciclesonide, 2 of 4 beclomethasone dipropionate, and 1 of 2 mometasone interventions demonstrated a statistically significant (p < 0.05) reduction in sputum eosinophil counts.
Conclusion: This study detected differences between ICS treatments however the clinical relevance is uncertain. There is insufficient evidence to suggest the superiority of one ICS treatment over another. Further research needs to be conducted to evaluate the relative impact of ICS products upon eosinophil counts, as well as in clarifying what quantitative level of change in baseline eosinophil counts is required to observe a change in symptom improvement and disease control.Renseignements sur l'article
Rubrique
Review & Clinical Practice
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3. Barnes PJ. (1996) Inhaled corticosteroids: new developments relevant to updating of asthma management guidelines. Respir Med 90: 379–384.
4. Barnes PJ. (1998) Anti-inflammatory actions of glucocorticoids: molecular mechanisms. Clin Sci 94: 557–572.
5. Djukanovic R, Sterk PJ, Fahy JV, Hargreave FE. Standardized methodology of sputum induction and processing. Eur Respir J 2002; 20:Suppl. 37, 1s–55s.
6. Lemiere CM, FitzGerald M. (2012) Canadian Thoracic Society 2012 guideline update: diagnosis and management of asthma in preschoolers, children and adults. Can Respir J 19(2): 127-164.
7. Rank MA, Hagan JB, Park MA, Podjasek JC, Samant SA, Volcheck GW, et al. (2013) The risk of asthma exacerbation after stopping low-dose inhaled corticosteroids: A systematic review and meta-analysis of randomized controlled trials. J Allergy Clin Immunol 131(3): 724-729.
8. Gan WQ, Man SP, Sin DD. (2005) Effects of inhaled corticosteroids on sputum cell counts in stable chronic obstructive pulmonary disease: a systematic review and a meta-analysis. BMC pulmonary medicine 5(1): 3.
9. Moher D, Liberati A, Tetzlaff J, Altman DG. (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151(4): 264-269.
10. Landis JR, Koch GG. (1977) The measurement of observer agreement for categorical data. Biometrics 33(1): 159-175.
11. The Cochrane Collaboration. (2009) Cochrane Handbook for Systematic Reviews of Interventions (Version 5.0.2). Oxford: Cochrane Collaboration.
12. Boushey H, Sorkness C, King T. (2005) Intermittent therapy effective for mild persistent asthma. J Fam Pract 54(7): 577-84.
13. Cao WL, Sun YC, Yao WZ. (2007) A study on a therapeutic protocol to improve the control of persistent asthma by monitoring sputum eosinophil counts. Zhonghua Jie He He Hu Xi Za Zhi 30(5): 334-338.
14. Chlumský J, Striz I, Terl M, Vondracek J. (2006) Strategy aimed at reduction of sputum eosinophils decreases exacerbation rate in patients with asthma. J Int Med Res 34(2): 129-139.
15. Cowan DC, Cowan JO, Palmay R, Williamson A, Taylor DR. (2010) Simvastatin in the treatment of asthma: lack of steroid-sparing effect. Thorax 65(10): 891-896.
16. Dahl R, Nielsen L, Kips J, Foresi A, Cauwenberge P, Tudoric N, et al. (2005) Intranasal and inhaled fluticasone propionate for pollen‐induced rhinitis and asthma. Allergy 60(7): 875-881.
17. Deykin A, Lazarus SC, Fahy JV, Wechsler ME, Boushey HA, Chinchilli VM, et al. (2005) Sputum eosinophil counts predict asthma control after discontinuation of inhaled corticosteroids. J Allergy Clin Immunol 115(4): 720-727.
18. Duong M, Amin R, Baatjes AJ, Kritzinger F, Qi Y, Meghji Z, et al. (2012) The effect of montelukast, budesonide alone, and in combination on exercise-induced bronchoconstriction. J Allergy Clin Immunol 130(2): 535-539.
19. Duong M, Gauvreau G, Watson R, Obminski G, Strinich T, Evans M, et al. (2007) The effects of inhaled budesonide and formoterol in combination and alone when given directly after allergen challenge. J Allergy Clin Immunol 119(2): 322-327.
20. Fagan HB, Harwood M. (2003) Use of sputum eosinophil count decreases asthma exacerbations. J Fam Pract 52(5): 353-354.
21. Heijink IH, Kauffman HF, Vellenga E, Veltman-Starkenburg CA, Postma DS, de Monchy JG. (2007) Effect of ciclesonide treatment on allergen-induced changes in T cell regulation in asthma. Int Arch Allergy Immunol 145(2): 111-121.
22. Horiguchi T, Hayashi N, Ohira D, Torigoe H, Ito T, Hirose M, et al. (2006) Usefulness of HFA-BDP for adult patients with bronchial asthma: randomized crossover study with fluticasone. J Asthma 43(7): 509-512.
23. Horiguchi T, Tachikawa S, Kondo R, Miyazaki J, Shiga M, Hirose M, et al. (2007) Comparative evaluation of the leukotriene receptor antagonist pranlukast versus the steroid inhalant fluticasone in the therapy of aged patients with mild bronchial asthma. Arzneimittelforschung 57(02): 87-91.
24. Hoshino M, Ohtawa J. (2012) Effects of adding omalizumab, an anti-immunoglobulin E antibody, on airway wall thickening in asthma. Respiration 83(6): 520-528.
25. Janson SL, Fahy JV, Covington JK, Paul SM, Gold WM, Boushey HA. (2003) Effects of individual self-management education on clinical, biological, and adherence outcomes in asthma. Am J Med 115(8): 620-626.
26. Jayaram L, Pizzichini M, Cook R, Boulet L, Lemiere C, Pizzichini E, et al. (2006) Determining asthma treatment by monitoring sputum cell counts: effect on exacerbations. Eur Resp J 27(3): 483-494.
27. Kawayama T, O'Byrne P, Watson R, Killian K, Duong M, Yoshida M, et al. (2006) Effects of inhaled ciclesonide on circulating T‐helper type 1/T‐helper type 2 cells in atopic asthmatics after allergen challenge. Clin Exp Allergy 36(11): 1417-1424.
28. Koopmans JG, Lutter R, Jansen HM, van der Zee, Jaring S. (2005) Adding salmeterol to an inhaled corticosteroid reduces allergen-induced serum IL-5 and peripheral blood eosinophils. J Allergy Clin Immunol 116(5): 1007-1013.
29. Lemière C, Tremblay C, FitzGerald M, Aaron SD, Leigh R, Boulet L, et al. (2011) Effects of a short course of inhaled corticosteroids in noneosinophilic asthmatic subjects. Can Respir J 18(5): 278-282.
30. Luijk B, Van Den Berge M, Kerstjens H, Postma D, Cass L, Sabin A, et al. (2008) Effect of an inhaled adenosine A2A agonist on the allergen‐induced late asthmatic response. Allergy 63(1): 75-80.
31. Ohbayashi H, Adachi M. (2008) Hydrofluoroalkane-beclomethasone dipropionate effectively improves airway eosinophilic inflammation including the distal airways of patients with mild to moderate persistent asthma as compared with fluticasone propionate in a randomized open double-cross study. Allergol Int 57(3): 231-239.
32. Ohbayashi H, Shibata N, Hirose T, Adachi M. (2009) Additional effects of pranlukast in salmeterol/fluticasone combination therapy for the asthmatic distal airway in a randomized crossover study. Pulm Pharmacol Ther 22(6): 574-579.
33. Ohbayashi H, Adachi M, Ichinose M, Ohta K, Kokubu F, Sano Y, et al. (2007) A multicenter, open-label, randomized comparison of suppressive effects on asthmatic inflammation of lower airways and improved effects on health-related QOL between HFA-BDP and fluticasone propionate. Arerugi 56(6): 577-586.
34. Palmqvist M, Bruce C, Sjöstrand M, Arvidsson P, Lötvall J. (2005) Differential effects of fluticasone and montelukast on allergen‐induced asthma. Allergy 60(1): 65-70.
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