title: Daily vs. intermittent inhaled corticosteroids for recurrent wheezing and mild persistent asthma: a systematic review with meta-analysis.
abstract: BACKGROUND
  Intermittent ICS treatment with SABA in response to symptoms, is an emerging strategy for control of mild-to-moderate asthma, and recurrent wheezing. This systematic revue compares the efficacy of daily vs. intermittent ICS among preschoolers, children and adults with persistent wheezing and mild to moderate stable persistent asthma.
  
  
  METHODS
  Systematic review of randomized, placebo-controlled trials with a minimum of 8 weeks of daily (daily ICS with rescue SABA during exacerbations) vs. intermittent ICS (ICS plus SABA at the onset of symptoms), were retrieved through different databases. Primary outcome was asthma exacerbations; secondary outcomes were pulmonary function tests, symptoms, days without symptoms, SABA use, corticosteroids use, days without rescue medication use, expired nitric oxide and serious adverse events.
  
  
  RESULTS
  Seven trials (1367 participants) met inclusion criteria there was no statistically significant difference in the rate of asthma exacerbations between those with daily vs. intermittent ICS (0.96; 95% CI: 0.86, 1.06, I(2) = 0%). In the sub-group analysis, no differences were seen in duration of studies, step-up strategy or age. However, compared to intermittent ICS, the daily ICS group had a significant increase in asthma-free days and non-significant decreases in rescue SABA use and exhaled nitric oxide measurement.
  
  
  CONCLUSIONS
  No significant differences between daily and intermittent ICS in reducing the incidence of asthma exacerbations was found. However, the daily ICS strategy was superior in many secondary outcomes. Therefore, this study suggests to not change daily for intermittent ICS use among preschoolers, children with persistent wheezing and adults with mild-to-moderate stable persistent asthma. International prospective register of systematic reviews http://www.crd.york.ac.uk/PROSPERO/ (CRD42012003228).
authors.affiliation: Departamento de Emergencia, Hospital Central de las Fuerzas Armadas, Av. 8 de Octubre 3020, Montevideo 11300, Uruguay. gustavo.javier.rodrigo@gmail.com
authors.forename: Gustavo J
authors.initials: GJ
authors.lastname: Rodrigo
authors.forename: José A
authors.initials: JA
authors.lastname: Castro-Rodríguez
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D018849:Controlled Clinical Trials as Topic; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012135:Respiratory Sounds / Q000187:drug effects*; D015983:Selection Bias; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents
keywords: API; Asthma; CI; Daily; FEV(1); HR; ICS; Inhaled corticosteroids; Intermittent; MD; PEF; RR; SABA; SAE; Treatment; asthma predictive index; confidence interval; forced volume in the first second; hazard ratio; inhaled corticosteroids; mean difference; peak expiratory flow; risk ratio; serious adverse effects; short-acting beta2-agonists