PT  - JOURNAL ARTICLE
AU  - Francine Ducharme
AU  - Bhupendrdasinh Chauhan
AU  - Caroline Chartrand
TI  - Intermittent <em>versus</em> daily inhaled corticosteroids (ICS) in children and adults with mild persistent asthma: A Cochrane review
DP  - 2012 Sep 01
TA  - European Respiratory Journal
PG  - P2083
VI  - 40
IP  - Suppl 56
4099  - http://erj.ersjournals.com/content/40/Suppl_56/P2083.short
4100  - http://erj.ersjournals.com/content/40/Suppl_56/P2083.full
SO  - Eur Respir J2012 Sep 01; 40
AB  - IntroductionAlthough guidelines recommend daily ICS in mild persistent asthma, most patients use, and many physicians prescribe, intermittent ICS.ObjectivesTo compare the safety and efficacy of intermittent versus daily ICS in mild persistent asthma.METHODS: Randomised trials comparing intermittent vs. daily ICS in children and adults were eligible. Outcomes included: patients requiring rescue oral steroids (primary efficacy), serious adverse health events (primary safety), hospitalisations, lung function, asthma control, adverse effects, and withdrawals.ResultsSix (4 children; 2 adult) parallel-group trials using beclomethasone or budesonide, were included. There was no significant group difference in patients requiring rescue oral steroids (RR=1.07, 95%CI 0.87, 1.32) and serious adverse events (RR=0.82, 95%CI 0.33, 2.03). Compared to daily ICS, intermittent ICS was associated with lower change in PEF, fewer control days, more β2-agonists use, and higher exhaled nitric oxide. There was no group difference in acute care visits, hospitalisations, FEV1, adverse effects, and withdrawals. Compared to intermittent, daily budesonide was associated with lower growth in children (MD=0.41cm, 95%CI 0.13, 0.69).ConclusionsIntermittent and daily ICS strategies did not significantly differ in the use of rescue oral steroids, nor did they reach equivalence. Daily ICS was superior to intermittent ICS in several indicators of lung function, airway inflammation, control, and reliever use. The findings would support the greater efficacy of daily ICS in children and adults with mild persistent asthma, while using the safest, and lowest effective dose of, ICS in children.