Inhaled corticosteroids in childhood asthma the story continues

Sixty-five trials met the inclusion criteria for this review . Fifty-six trials (19 paediatric trials) contributed data (representing total of 10,005 adults and 3,333 children); 21 trials were of high methodological quality; 44 were published in full-text. All trials pertained to patients with mild or moderate persistent asthma. Trial durations varied from four to 52 weeks. The median dose of inhaled corticosteroids was quite homogeneous at 200 µg/day of microfine hydrofluoroalkane-propelled beclomethasone or equivalent (HFA-BDP eq). Patients treated with anti-leukotrienes were more likely to suffer an exacerbation requiring systemic corticosteroids (N = 6077 participants; risk ratio ( RR ) , 95% confidence interval ( CI ) , ). For every 28 (95% CI 15 to 82) patients treated with anti-leukotrienes instead of inhaled corticosteroids, there was one additional patient with an exacerbation requiring rescue systemic corticosteroids. The magnitude of effect was significantly greater in patients with moderate compared with those with mild airway obstruction ( RR , 95% CI , versus RR , 95% CI , ), but was not significantly influenced by age group (children representing 23% of the weight versus adults), anti-leukotriene used, duration of intervention , methodological quality, and funding source. Significant group differences favouring inhaled corticosteroids were noted in most secondary outcomes including patients with at least one exacerbation requiring hospital admission (N = 2715 participants; RR ; 95% CI to ), the change from baseline FEV 1 (N = 7128 participants; mean group difference ( MD ) 110 mL, 95% CI 140 to 80) as well as other lung function parameters, asthma symptoms, nocturnal awakenings, rescue medication use, symptom-free days, the quality of life, parents' and physicians ' satisfaction. Anti-leukotriene therapy was associated with increased risk of withdrawals due to poor asthma control (N = 7669 participants; RR ; 95% CI to ). For every thirty one (95% CI 22 to 47) patients treated with anti-leukotrienes instead of inhaled corticosteroids, there was one additional withdrawal due to poor control . Risk of side effects was not significantly different between both groups.

Unfamiliarity with these newer inhalers has been the source of some recently reported errors. A patient discharged from the hospital on Spiriva HandiHaler was readmitted 3 days later after taking 3 Spiriva capsules by mouth each day. He was unaware that the capsule was to be placed in the device so its contents could be inhaled. A color-blind patient was unable to tell if the indicator window on a Tudorza Pressair inhaler was red or green. The window turns green when the inhaler is loaded with a dose and ready to use, and red when the dose has been completely inhaled. Errors have happened to healthcare providers, too. In the pharmacy, an order for Incruse Ellipta was mistaken as “Increase Ellipta,” and the pharmacist dispensed Breo Ellipta, the only “Ellipta” inhaler with which he was familiar.

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website ( http:///c4Rm4p ) for more information if you do not have access to a take-back program.

While the use of inhaled LABAs are still recommended in asthma guidelines for the resulting improved symptom control, [22] further concerns have been raised, by a large meta-analysis of the pooled results from 19 trials with 33,826 participants, that salmeterol may increase the small risks of asthma deaths, and this additional risk is not reduced with the additional use of inhaled steroids (., as with the combination product fluticasone/salmeterol ). [23] This seems to occur because although LABAs relieve asthma symptoms, they also promote bronchial inflammation and sensitivity without warning. [24]

Inhaled corticosteroids in childhood asthma the story continues

inhaled corticosteroids in childhood asthma the story continues

While the use of inhaled LABAs are still recommended in asthma guidelines for the resulting improved symptom control, [22] further concerns have been raised, by a large meta-analysis of the pooled results from 19 trials with 33,826 participants, that salmeterol may increase the small risks of asthma deaths, and this additional risk is not reduced with the additional use of inhaled steroids (., as with the combination product fluticasone/salmeterol ). [23] This seems to occur because although LABAs relieve asthma symptoms, they also promote bronchial inflammation and sensitivity without warning. [24]

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