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Does the use of inhaled corticosteroids in asthma benefit lung function in the long-term? A systematic review and meta-analysis

Citation

Tan, DJ and Bui, DS and Dai, X and Lodge, CJ and Lowe, AJ and Thomas, PS and Jarvis, D and Abramson, MJ and Walters, EH and Perret, JL and Dharmage, SC, Does the use of inhaled corticosteroids in asthma benefit lung function in the long-term? A systematic review and meta-analysis, European Respiratory Review, 30, (159) pp. 1-14. ISSN 0905-9180 (2021) [Refereed Article]


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Copyright ERS 2021. This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

DOI: doi:10.1183/16000617.0185-2020

Abstract

While asthma is known to be associated with an increased risk of progressive lung function impairments and fixed airflow obstruction, there is ongoing debate on whether inhaled corticosteroids (ICS) modify these long-term risks. Searches were performed of the PubMed, Embase and CENTRAL databases up to 22 July 2019 for studies with follow-up ≥1 year that investigated the effects of maintenance ICS on changes in lung function in asthma.Inclusion criteria were met by 13 randomised controlled trials (RCTs) (n=11 678) and 11 observational studies (n=3720). Median (interquartile range) follow-up was 1.0 (1-4) and 8.4 (3-28) years, respectively. In the RCTs, predominantly in individuals with mild asthma, ICS use was associated with improved pre-bronchodilator (BD) forced expiratory volume in 1 s (FEV1) across all age groups (2.22% predicted (95% CI 1.32-3.12), n=8332), with similar estimates of strength in association for children and adults. Improvements in post-BD FEV1 were observed in adults (1.54% (0.87-2.21), n=3970), but not in children (0.20% (-0.49-0.90), n=3924) (subgroup difference, p=0.006). Estimates were similar between smokers and nonsmokers. There were no RCT data on incidence of fixed airflow obstruction. In the observational studies, ICS use was associated with improved pre-BD FEV1 in children and adults. There were limited observational data for post-BD outcomes.In patients with mild asthma, maintenance ICS are associated with modest, age-dependent improvements in long-term lung function, representing an added benefit to the broader clinical actions of ICS in asthma. There is currently insufficient evidence to determine whether treatment reduces incidence of fixed airflow obstruction in later life.

Item Details

Item Type:Refereed Article
Research Division:Biomedical and Clinical Sciences
Research Group:Cardiovascular medicine and haematology
Research Field:Respiratory diseases
Objective Division:Health
Objective Group:Clinical health
Objective Field:Treatment of human diseases and conditions
UTAS Author:Walters, EH (Professor Haydn Walters)
ID Code:146558
Year Published:2021
Web of Science® Times Cited:2
Deposited By:Medicine
Deposited On:2021-09-13
Last Modified:2021-11-23
Downloads:4 View Download Statistics

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