title: Principal findings of systematic reviews for chronic treatment in childhood asthma.
abstract: OBJECTIVE
  To summarize the principal findings pertaining to most effective long-term pharmacologic treatment of childhood asthma.
  
  
  METHODS
  Systematic reviews of randomized clinical trials (SRCTs) on pharmacologic chronic treatment in children (1-18 years) with persistent asthma were retrieved through MEDLINE, EMBASE, CINAHL, SCOPUS, and CDSR (up to January2014).
  
  
  RESULTS
  One hundred eighty-three SRCTs were searched from databases. Among those, 39 SRCTs were included: two were related to step 1, 24 to step 2, nine to steps 3 and 4, and four to step 5 (according with NAEPP and GINA guidelines). The methodological quality of these SRCTs was determined by using the AMSTAR tool.
  
  
  RESULTS
  For step 1: addition of ipatropium bromide to short-acting beta2-agonists does not show any benefit. For step 2: in preschoolers, inhaled corticosteroids (ICSs) reduce severe exacerbations and improve other clinical and lung function parameters. In children, ICSs are superior to leukotriene receptor antagonist (LTRA), cromones, or xantines in reducing severe exacerbations, improving lung function and other clinical outcomes. Fluticasone propionate (FP) is better than beclomethasone dipropionate (BDP) or budesonide only for lung function; but similar to hydrofluoroalkane-BDP or to ciclosenide. Compared to low ICSs doses, moderate doses result in only better lung function, but this is not true for FP. For steps 3 and 4: adding LTRA to ICS confers a small benefit; adding LABA improves lung function but does not reduce exacerbations more than double or higher ICS doses. For step 5: adding omalizumab decreases exacerbations.
  
  
  CONCLUSIONS
  SRCTs are useful for guiding decisions in chronic childhood asthma treatment.
authors.affiliation: Departments of Pediatrics and Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile , Santiago , Chile .
authors.forename: Jose A
authors.initials: JA
authors.lastname: Castro-Rodriguez
authors.forename: Gustavo J
authors.initials: GJ
authors.lastname: Rodrigo
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Rodriguez-Martinez
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006801:Humans; D020024:Leukotriene Antagonists / Q000627:therapeutic use
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D020024:Leukotriene Antagonists
keywords: AMSTAR; Adolescent; children; chronic asthma management; meta-analysis; systematic review; treatment