Effectiveness of prophylactic inhaled steroids in childhood asthma: a systemic review of the literature.
BACKGROUND
There has been no systematic appraisal of the evidence regarding the effectiveness of prophylactic inhaled steroids in childhood asthma.


OBJECTIVE
We sought to evaluate the effectiveness of prophylactic inhaled steroids in childhood asthma.


METHODS
A MEDLINE search from January 1966 through December 1996 was used to identify pertinent English-language publications. All randomized, double-blind, placebo-controlled trials of prophylactic inhaled steroid therapy for childhood asthma that included data on clinical outcomes (symptom scores and concomitant drug use) or laboratory outcomes (peak expiratory flow rate) were included.


RESULTS
In total, 24 of 93 studies retrieved met the inclusion criteria. The overall weighted relative improvement in mean total symptom score (inhaled steroid vs placebo) was 50% (95% confidence interval [CI]: 49%, 51%), the overall weighted relative decrease in mean concomitant beta2-agonist use (inhaled steroid vs placebo) was 37% (95% CI: 36%, 38%), and the overall weighted relative decrease in mean concomitant oral steroid use (inhaled steroid vs placebo) was 68% (95% CI: 66%, 70%). The overall weighted absolute improvement in mean peak expiratory flow rate (inhaled steroid vs placebo) was 38 L/min (95% CI: 34.3 L/min, 41.7 L/min).


CONCLUSIONS
Prophylactic inhaled steroids are effective, compared with placebo, in improving both clinical and laboratory outcomes in childhood asthma.
Calpin
C
C
Pediatric Outcomes Research Team, The Hospital for Sick Children and the Department of Pediatrics, University of Toronto, Ontario, Canada.
Macarthur
C
C
Stephens
D
D
Feldman
W
W
Parkin
P C
PC
D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D001249:Asthma / Q000503:physiopathology / Q000517:prevention & control; D004311:Double-Blind Method; D005938:Glucocorticoids / Q000009:adverse effects / Q000627:therapeutic use; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D010919:Placebos
D000305:Adrenal Cortex Hormones; D005938:Glucocorticoids; D010919:Placebos