Asthma and other recurrent wheezing disorders in children (chronic)

Overview

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Substantive changes at this update

Corticosteroids (inhaled) New evidence added.[8][9][13][14][15][16][17][20][10][35][36][37][38][39][40] Categorisation unchanged (Beneficial).

Leukotriene receptor antagonists (oral) New evidence added.[14][15][45][46][35][36][37][38][39][40] Categorisation unchanged (Likely to be beneficial).

Long-acting beta2 agonists New evidence added.[50][52][53] Categorisation changed (from Trade-off between benefits and harms to Likely to be ineffective or harmful).

Theophylline (oral) No new evidence added but existing evidence re-evaluated. Categorisation changed (from Trade-off between benefits and harms to Likely to be ineffective or harmful).

Increased dose of inhaled corticosteroid New evidence added.[59][60][62][63][64] Categorisation unchanged (Unknown effectiveness) because evidence remains insufficient to assess the effects of this intervention.

Addition of long-acting beta2 agonist New evidence added.[62][63][64] Categorisation changed (from Unknown effectiveness to Likely to be beneficial).

Addition of oral leukotriene receptor antagonists New evidence added,[69] which identified no new RCTs. New evidence added.[63] Existing evidence re-evaluated and categorisation changed (from Unknown effectiveness to Likely to be beneficial by consensus).

Addition of omalizumab New option added.[74][75][76][77][78] Categorised as Unknown effectiveness because evidence from two RCTs, one reported in several publications, is insufficient to assess the effects of this intervention.

Abstract

INTRODUCTION: Childhood asthma is the most common chronic paediatric illness. There is no cure for asthma but good treatment to palliate symptoms is available. Asthma is more common in children with a personal or family history of atopy, increased severity and frequency of wheezing episodes, and presence of variable airway obstruction or bronchial hyperresponsiveness. Precipitating factors for symptoms and acute episodes include infection, house dust mites, allergens from pet animals, exposure to tobacco smoke, and exercise. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of single-agent prophylaxis in children taking as-needed inhaled beta2 agonists for asthma? What are the effects of additional prophylactic treatments in childhood asthma inadequately controlled by standard-dose inhaled corticosteroids? We searched: Medline, Embase, The Cochrane Library, and other important databases up to June 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 48 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: beta2 agonists (long-acting), corticosteroids (inhaled standard or higher doses), leukotriene receptor antagonists (oral), omalizumab, and theophylline (oral).

Cite as

Turner SW, Friend AJ, Okpapi A. Asthma and other recurrent wheezing disorders in children (chronic). Systematic review 302. BMJ Clinical Evidence. . 2012 January. Accessed [date].

Latest citations

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