We identified seven randomised trials (5997 participants) of good quality with a duration of six months to three years. All of the trials compared ICS/LABA combination inhalers with LABA and ICS as individual components. Four of these trials included fluticasone and salmeterol monocomponents and the remaining three included budesonide and formoterol monocomponents. There was no statistically significant difference in our primary outcome , the number of patients experiencing exacerbations ( odds ratio ( OR ) ; 95% CI to ), or the rate of exacerbations per patient year (rate ratio ( RR ) ; 95% CI to ) between inhaled corticosteroids and long-acting beta 2 -agonists. The incidence of pneumonia, our co-primary outcome , was significantly higher among patients on inhaled corticosteroids than on long-acting beta 2 -agonists whether classified as an adverse event ( OR ; 95% CI to ) or serious adverse event (Peto OR ; 95% CI to ). Results of the secondary outcomes analysis were as follows. Mortality was higher in patients on inhaled corticosteroids compared to patients on long-acting beta 2 -agonists (Peto OR ; 95% CI to ), although the difference was not statistically significant . Patients treated with beta 2 -agonists showed greater improvements in pre-bronchodilator FEV 1 compared to those treated with inhaled corticosteroids ( mean difference ( MD ) mL; 95% CI to ), whilst greater improvements in health-related quality of life were observed in patients receiving inhaled corticosteroids compared to those receiving long-acting beta 2 -agonists (St George's Respiratory Questionnaire (SGRQ) MD -; 95% CI - to -). In both cases the differences were statistically significant but rather small in magnitude. There were no statistically significant differences between ICS and LABA in the number of hospitalisations due to exacerbations, number of mild exacerbations, peak expiratory flow, dyspnoea , symptoms scores, use of rescue medication, adverse events, all cause hospitalisations, or withdrawals from studies.
to mg via oral inhalation every 4 to 6 hours as needed for symptoms of bronchospasm is recommended by the National Asthma Education and Prevention Program (NAEPP) Expert Panel. For acute asthma exacerbations, the NAEPP recommends mg/kg/dose (Min: mg/dose) via oral inhalation every 20 minutes for 3 doses, then to mg/kg/dose (Max: 10 mg/dose) every 1 to 4 hours as needed or mg/kg/hour by continuous nebulization. The Global Initiative for Asthma (GINA) guidelines recommend mg via nebulization with mouthpiece (and facemask in those younger than 4 years) every 20 minutes for the first hour for acute exacerbations, with reassessment thereafter (further dosing not specified). According to FDA-approved labeling, initial dosing for albuterol % solution is to mg/kg/dose, with subsequent dosing titrated to achieve desired clinical response. Max: mg/dose 3 to 4 times daily; do not exceed 4 doses/day. For patients weighing at least 15 kg, the % solution may be used at a dose of mg via oral inhalation 3 to 4 times daily as needed. Doses should be delivered over 5 to 15 minutes.