The risk of asthma exacerbation after reducing inhaled corticosteroids: a systematic review and meta‐analysis of randomized controlled trials. Issue 4 (26th February 2014)

• Record Type: Journal Article
• Authors: Hagan, J. B.; Samant, S. A.; Volcheck, G. W.; Li, J. T.; Hagan, C. R.; Erwin, P. J.; Rank, M. A.
• Is Part Of: Allergy. Volume 69:Issue 4(2014:Apr.)
• Page Start: 510
• Page End: 516
• Publication Date: 2014-02-26
• Subjects: Allergy -- Periodicals; 616.97
• DOI: 10.1111/all.12368
• Languages: English
• ISSNs: 0105-4538

Abstract

<abstract abstract-type="main" id="all12368-abs-0001"> <title>Abstract</title> <sec id="all12368-sec-0001" sec-type="section"> <title>Background</title> <p>Asthma guidelines suggest reducing controller medications when asthma is stable.</p> </sec> <sec id="all12368-sec-0002" sec-type="section"> <title>Methods</title> <p>The purpose of the study is to estimate the risk of asthma exacerbation in stable asthmatics who reduce inhaled corticosteroids (ICS) compared to those who maintain a stable ICS dose. We identified articles from a systematic review of English and non‐English articles using MEDLINE, EMBASE, Web of Science, and CENTRAL (inception to May 25, 2013). We included randomized controlled trials (RCTs) with a stable asthma run‐in period of 4 weeks or more, an intervention to reduce ICS, and a follow‐up period of at least 3 months.</p> </sec> <sec id="all12368-sec-0003" sec-type="section"> <title>Results</title> <p>The search strategy identified 2253 potential articles, of which 206 were reviewed at the full‐text level and 6 met criteria for inclusion. The relative risk of an asthma exacerbation in individuals who reduced ICS compared to those who maintained the same ICS dose was 1.25 (95% CI 0.96, 1.62; <italic>P</italic> = 0.10; <italic>I</italic><sup>2</sup> = 0%) in studies with a mean follow‐up of 22 weeks. Individuals who reduced ICS had a decreased% predicted FEV<sub>1</sub> of 0.87% (95% CI −1.58%, 3.33%; <italic>P</italic> = 0.49, <italic>I</italic><sup>2</sup> = 58%) and a decreased mean morning peak expiratory flow of 9.57 l/min (95% CI 1.25, 17.90; <italic>P</italic> = 0.02; <italic>I</italic><sup>2</sup> = 74%) compared to those individuals who maintained a stable ICS dose.</p> </sec> <sec id="all12368-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Asthma exacerbations were statistically no more likely among individuals who reduced ICS compared to those who maintained their ICS dose, supporting current guidelines which recommend decreasing ICS by 50% after a period of asthma stability.</p> </sec> </abstract>