The Journal of Allergy and Clinical Immunology
Volume 119, Issue 2 , Pages 344-350, February 2007

Differential effects of maintenance long-acting β-agonist and inhaled corticosteroid on asthma control and asthma exacerbations

  • Peter G. Gibson, MBBS(Hons), FRACP

      Affiliations

    • From the Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton
    • School of Medicine and Population Health, University of Newcastle, Callaghan
    • Cooperative Research Centre for Asthma, Camperdown
    • Corresponding Author InformationReprint requests: Peter G. Gibson, MBBS(Hons), FRACP, Level 3 HMRI, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Centre, NSW 2310, Australia.
    • ,
  • Heather Powell, MMedSci

      Affiliations

    • From the Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, University of Newcastle, New Lambton
    • Cooperative Research Centre for Asthma, Camperdown
    • ,
  • Francine M. Ducharme, MD, FRCP

      Affiliations

    • Department of Pediatrics, Montreal Children's Hospital of the McGill University Health Centre

Received 23 August 2006; received in revised form 22 October 2006; accepted 30 October 2006.

New Lambton, Callaghan, and Camperdown, Australia, and Montreal, Quebec, Canada

Background

Combination therapy with long-acting β-agonists (LABAs)/inhaled corticosteroids (ICSs) has become established as effective maintenance treatment for asthma.

Objective

To compare and contrast the efficacy and safety of LABAs/ICSs against different maintenance ICS strategies in adults with asthma.

Methods

Cochrane systematic reviews of randomized controlled trials (to April 2004) were identified that compared the addition of LABA to ICS against 3 inhaled corticosteroid strategies: (1) a similar dose (n = 4312 subjects), (2) a higher dose (n = 4951), and (3) a similar dose in steroid-naive subjects (n = 968). The outcomes evaluated were asthma exacerbations, asthma control, and adverse effects. Pediatric studies were excluded.

Results

The addition of LABA to ICSs significantly reduced the risk of exacerbations compared with a similar ICS dose, number needed to treat = 18. The effects of LABA/ICSs on exacerbations compared with the other maintenance inhaled corticosteroid strategies were not statistically significant. LABA added to inhaled corticosteroids led to significant improvements in asthma control compared with all 3 maintenance ICS strategies. There was an increased risk of tremor with LABA/ICSs that reached significance for initial therapy, number needed to harm = 21, and compared with higher ICS doses, number needed to harm = 74.

Conclusion

Maintenance asthma therapy with LABA/ICSs has differential effects on asthma control and asthma exacerbations.

Clinical implications

The greatest benefit and least harm of LABAs comes when they are added to a similar ICS dose in adults with symptomatic asthma.

Key words: Asthma, long-acting beta-agonist, inhaled corticosteroid, systematic review

Abbreviations used: ICS, Inhaled corticosteroid, LABA, Long-acting β-agonist, NNH, Number needed to harm, NNT, Number needed to treat, OCS, Oral corticosteroid, PEF, Peak expiratory flow, RCT, Randomized controlled trial, RR, Relative risk, SMD, Standardized mean difference, WMD, Weighted mean difference

 

 Supported by the Cooperative Research Centre for Asthma, Camperdown, Australia.Disclosure of potential conflict of interest: P. G. Gibson has received grant support from and is on the speakers' bureau for GlaxoSmithKline. F. M. Ducharme has consulting arrangements with AstraZeneca and has received grant support from GlaxoSmithKline. H. Powell has declared that she has no conflict of interest.

PII: S0091-6749(06)03025-9

doi:10.1016/j.jaci.2006.10.043

The Journal of Allergy and Clinical Immunology
Volume 119, Issue 2 , Pages 344-350, February 2007

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