INTRODUCTION: About 10% of adults have suffered an attack of asthma, and up to 5% of these have severe disease that responds poorly to treatment. Patients with severe disease have an increased risk of death, but patients with mild-to-moderate disease are also at risk of exacerbations. Most guidelines about the management of asthma follow stepwise protocols. This review does not endorse or follow any particular protocol, but presents the evidence about specific interventions. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for chronic asthma? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 54 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: adding anti-IgE treatment; beta(2) agonists (adding long-acting inhaled beta(2) agonists when asthma is poorly controlled by inhaled corticosteroids, or short-acting inhaled beta(2) agonists as needed for symptom relief); inhaled corticosteroids (low dose and increasing dose); leukotriene antagonists (with or without inhaled corticosteroids); and theophylline (when poorly controlled by inhaled corticosteroids).
INTRODUCTION: About 10% of adults have suffered an attack of asthma, and up to 5% of these have severe disease that responds poorly to treatment. Patients with severe disease have an increased risk of death, but patients with mild-to-moderate disease are also at risk of exacerbations. Most guidelines about the management of asthma follow stepwise protocols. This review does not endorse or follow any particular protocol, but presents the evidence about specific interventions. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for chronic asthma? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2010 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 54 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: adding anti-IgE treatment; beta(2) agonists (adding long-acting inhaled beta(2) agonists when asthma is poorly controlled by inhaled corticosteroids, or short-acting inhaled beta(2) agonists as needed for symptom relief); inhaled corticosteroids (low dose and increasing dose); leukotriene antagonists (with or without inhaled corticosteroids); and theophylline (when poorly controlled by inhaled corticosteroids).
Authors: D B Price; D Hernandez; P Magyar; J Fiterman; K M Beeh; I G James; S Konstantopoulos; R Rojas; J A van Noord; M Pons; L Gilles; J A Leff Journal: Thorax Date: 2003-03 Impact factor: 9.139
Authors: Elliot Israel; Paul S Chervinsky; Bruce Friedman; Julius Van Bavel; Carol S Skalky; Asma F Ghannam; Steven R Bird; Jonathan M Edelman Journal: J Allergy Clin Immunol Date: 2002-12 Impact factor: 10.793
Authors: Romain A Pauwels; Søren Pedersen; William W Busse; Wan C Tan; Yu-Zhi Chen; Stefan V Ohlsson; Anders Ullman; Carl Johan Lamm; Paul M O'Byrne Journal: Lancet Date: 2003-03-29 Impact factor: 79.321
Authors: David S Pearlman; Martha V White; Allen K Lieberman; Pamela J Pepsin; Chris Kalberg; Amanda Emmett; Brian Bowers; Kathleen A Rickard; Paul Dorinsky Journal: Ann Allergy Asthma Immunol Date: 2002-02 Impact factor: 6.347
Authors: R A Baumgartner; G Martinez; J M Edelman; G G Rodriguez Gomez; M Bernstein; S Bird; R Angner; A Polis; S B Dass; S Lu; T F Reiss Journal: Eur Respir J Date: 2003-01 Impact factor: 16.671
Authors: Charles Banov; William C Howland; William R Lumry; Bhash Parasuraman; Thomas Uryniak; Bengt Liljas Journal: Allergy Asthma Proc Date: 2003 Mar-Apr Impact factor: 2.587