title: Effect of inhaled corticosteroids on bronchial responsiveness in patients with "corticosteroid naive" mild asthma: a meta-analysis.
abstract: BACKGROUND
  Inhaled corticosteroids are the most efficacious anti-inflammatory drugs in asthma. International guidelines also advocate the early introduction of inhaled corticosteroids in corticosteroid naive patients. A study was undertaken to assess the effects of inhaled corticosteroids on bronchial hyperresponsiveness in patients with corticosteroid naive asthma by conventional meta-analysis.
  
  
  METHODS
  A Medline search of papers published between January 1966 and June 1998 was performed and 11 papers were selected in which the patients had no history of treatment with inhaled or oral corticosteroids. Bronchial responsiveness to bronchoconstricting agents was considered as the main outcome parameter. Doubling doses (DD) of histamine or methacholine were calculated.
  
  
  RESULTS
  The total effect size of inhaled corticosteroids (average daily dose 1000 microg) versus placebo in the 11 studies was +1.16 DD (95% confidence interval (CI) +0.76 to +1.57). When only the eight short term studies (2-8 weeks) were analysed the effect size of the bronchoconstricting agent was +0.91 DD (95% CI +0.65 to +1.16). No relationship was found between the dose of inhaled corticosteroid used and the effect on bronchial responsiveness.
  
  
  CONCLUSIONS
  This meta-analysis in patients with corticosteroid naive asthma indicates that, on average, high doses of inhaled corticosteroids decrease bronchial hyperresponsiveness in 2-8 weeks. It remains unclear whether there is a dose-response relationship between inhaled corticosteroids and effect on bronchial hyperresponsiveness.
authors: Department of General Practice and Social Medicine, P O Box 9101, 6500 HB Nijmegen, The Netherlands.
authors: P M
authors: PM
authors: van Grunsven
authors: C P
authors: CP
authors: van Schayck
authors: J
authors: J
authors: Molema
authors: R P
authors: RP
authors: Akkermans
authors: C
authors: C
authors: van Weel
mesh_terms: D000280:Administration, Inhalation; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D016535:Bronchial Hyperreactivity / Q000175:diagnosis / Q000188:drug therapy*; D001985:Bronchial Provocation Tests; D016085:Bronchoconstrictor Agents; D004334:Drug Administration Schedule; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000627:therapeutic use; D006632:Histamine; D006801:Humans; D016210:Methacholine Chloride
chemical_list: D000893:Anti-Inflammatory Agents; D016085:Bronchoconstrictor Agents; D005938:Glucocorticoids; D016210:Methacholine Chloride; D006632:Histamine