scholarly journals Efficacy of inhaled corticosteroids for patients with asthma: a descriptive review of randomized controlled trials

2015 ◽  
Vol 5 (1) ◽  
pp. 41-50
Author(s):  
Mostafa Alabousi ◽  
Abdullah Alabousi ◽  
Natalie Ambeault ◽  
John Riva
Keyword(s):  
Fluticasone Propionate ◽  
Full Text ◽  
Beclomethasone Dipropionate ◽  
Search Strategy ◽  
Inhaled Corticosteroids ◽  
Controlled Trials ◽  
Sputum Eosinophil ◽  
Randomized Controlled ◽  
Eosinophil Counts ◽  
Full Text Screening

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.

scholarly journals Inhaled Corticosteroids and the Pneumonia Risk in Patients With Chronic Obstructive Pulmonary Disease: A Meta-analysis of Randomized Controlled Trials

2021 ◽  
Vol 12 ◽  
Author(s):  
Hong Chen ◽  
Jian Sun ◽  
Qiang Huang ◽  
Yongqi Liu ◽  
Mengxin Yuan ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Controlled Trials ◽  
Response Relationship ◽  
Dose Response Relationship ◽  
Obstructive Pulmonary Disease ◽  
Randomized Controlled ◽  
Copd Patients ◽  
Baseline Characteristics

Background: Whether all types of inhaled corticosteroids (ICSs) would increase the pneumonia risk in patients with chronic obstructive pulmonary disease (COPD) remains controversial. We aimed to assess the association between ICSs treatment and pneumonia risk in COPD patients, and the impact of medication details and baseline characteristics of patients on the association.Methods: Four databases (PubMed, Embase, Cochrane Library, and Clinical Trials.gov) were searched to identify eligible randomized controlled trials (RCTs) comparing ICSs treatment with non-ICSs treatment on the pneumonia risk in COPD patients. Pooled results were calculated using Peto odds ratios (Peto ORs) with corresponding 95% confidence intervals (CIs).Results: A total of 59 RCTs enrolling 103,477 patients were analyzed. All types of ICSs significantly increased the pneumonia risk (Peto OR, 1.43; 95% CI, 1.34–1.53). Subgroup analysis showed that there was a dose-response relationship between ICSs treatment and pneumonia risk (low-dose: Peto OR, 1.33; 95% CI, 1.22–1.45; medium-dose: Peto OR, 1.50; 95% CI, 1.28–1.76; and high-dose: Peto OR, 1.64; 95% CI, 1.45–1.85). Subgroup analyses based on treatment durations and baseline characteristics (severity, age, and body mass index) of patients were consistant with the above results. Subgroup analysis based on severity of pneumonia showed that fluticasone (Peto OR, 1.75; 95% CI, 1.44–2.14) increased the risk of serious pneumonia, while budesonide and beclomethasone did not.Conclusions: ICSs treatment significantly increased the risk of pneumonia in COPD patients. There was a dose-response relationship between ICSs treatment and pneumonia risk. The pneumonia risk was related with COPD severity.

scholarly journals Association between inhaled corticosteroids and upper respiratory tract infection in patients with chronic obstructive pulmonary disease: a meta-analysis of randomized controlled trials

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hong Chen ◽  
Yulin Feng ◽  
Ke Wang ◽  
Jing Yang ◽  
Yuejun Du
Keyword(s):  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
Controlled Trials ◽  
High Dose ◽  
Upper Respiratory Tract ◽  
Short Term ◽  
Obstructive Pulmonary Disease ◽  
Randomized Controlled ◽  
Upper Respiratory

Abstract Background We aimed to assess the association between inhaled corticosteroids (ICSs) and the risk of upper respiratory tract infection (URTI) in patients with chronic obstructive pulmonary disease (COPD). Methods PubMed, Embase, Cochrane Library and Clinical Trials.gov were searched from inception to October 2019. Randomized controlled trials (RCTs) of any ICSs vs control for COPD with reporting of URTI as an adverse event were included. The study was registered with PROSPERO prospectively (#CRD42020153134). Results Seventeen RCTs (20,478 patients) were included. ICSs significantly increased the risk of URTI in COPD patients (RR, 1.13; 95% CI 1.03–1.24; P = 0.01; heterogeneity: I2 = 7%). Futher subgroup analyses suggested that short-term use of ICSs increased the risk of URTI (RR, 1.29; 95% CI 1.06–1.56; P = 0.01; heterogeneity: I2 = 14%) but not for long-term use (RR, 1.08; 95% CI 0.97–1.2; P = 0.14; heterogeneity: I2 = 0%). Short-term use of high-dose fluticasone increased the risk of URTI (RR, 1.33; 95% CI 1.03–1.71; P = 0.03; heterogeneity: I2 = 0%) but not for long-term use (RR, 1.12; 95% CI 0.97–1.29; P = 0.13; heterogeneity: I2 = 50%). Medium-dose (RR, 0.97; 95% CI 0.71–1.32; P = 0.84; heterogeneity: I2 = 0%) and low-dose (RR, 1.39; 95% CI 0.92–2.1; P = 0.12; heterogeneity: I2 = 30%) fluticasone did not increase the risk of URTI regardless of duration. Neither mometasone (RR, 1.05; 95% CI 0.87–1.26; P = 0.61; heterogeneity: I2 = 0%) nor budesonide (RR, 1.08; 95% CI 0.77–1.5; P = 0.67; heterogeneity: I2 = 46%) increased the risk of URTI, regardless of dosage or duration. Conclusions Long-term use of ICSs does not increase the risk of URTI in patients with COPD. Short-term use of high-dose fluticasone increases the risk of URTI in patients with COPD, but not mometasone or budesonide.

scholarly journals THE ROLE OF NEBULIZED BECLOMETHASONE DIPROPIONATE IN THE TREATMENT OF BRONCHIAL ASTHMA

2013 ◽  
Vol 10 (6) ◽  
pp. 41-50
Author(s):  
S N Avdeev
Keyword(s):  
Bronchial Asthma ◽  
Beclomethasone Dipropionate ◽  
Inhalation Therapy ◽  
Controlled Trials ◽  
Portable Devices ◽  
Efficacy And Safety ◽  
Inhaled Corticosteroid ◽  
Randomized Controlled ◽  
Steroid Dependent

Beclomethasone dipropionate (BDP, Clenil UDV) is a well-studied inhaled corticosteroid for the treatment of patients with bronchial asthma (BA). Randomized controlled trials have shown that nebulized therapy with BDP was similar in its efficacy and safety to inhalation therapy with budesonide or fluticasone. Preferred patients for the treatment with nebulized BDP are elderly patients with asthma, unable to correctly perform inhalation with portable devices, patients with steroid-dependent asthma, and patients with a temporary loss of asthma control.

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