Scolaris Content Display Scolaris Content Display

Budesonide versus placebo for chronic asthma in children and adults

Collapse all Expand all

Abstract

available in

Background

Inhaled budesonide is a widely used inhaled corticosteroid for asthma.

Objectives

The objectives of this review was to compare the efficacy of budesonide with placebo in the treatment of chronic asthma.

Search methods

The Cochrane Airways Group Trial Register and reference lists of articles was searched. We contacted trialists for additional studies and searched abstracts of major respiratory society meetings (1997‐1999).

Selection criteria

Randomised trials in children and adults comparing budesonide to placebo in the treatment of chronic asthma.

Data collection and analysis

Two reviewers independently assessed articles for inclusion and methodological quality. One reviewer extracted data.

Main results

43 studies met the inclusion criteria (2801 paticipants). In non‐oral steroid treated asthmatics, budesonide led to significant improvements in a number of measures of airway function. These included FEV1, Weighted Mean Difference (WMD) 3.7% predicted (95% CI 0.1, 7.2%); improvement in morning peak flow (PEF) from baseline WMD 29 L/min (95% CI 22, 36 L/min); improvement in evening PEF from baseline WMD 21 L/min (95% CI 13, 29 L/min). Varying methods of reporting symptoms limited the pooling of studies but all high methodological quality studies demonstrated significant improvements compared to placebo. Health status was not reported. Risk of trial withdrawal due to asthma exacerbation was lower with budesonide compared to placebo, relative risk 0.17 (95% CI 0.09, 0.33). Doses of 500‐800 mcg/d appeared to have slightly larger effect sizes than lower doses, but no advantage for high doses were apparent. A single high quality RCT reported significant reductions in daily prednisolone requirement and the number of patients able to discontinue prednisolone completely in budesonide treated subjects compared to placebo. No difference in risk of oropharyngeal soreness/hoarseness or oral Candidiasis was apparent for budesonide compared to placebo. Long‐term risk of adrenal insufficiency was not reported.

Authors' conclusions

This review strongly supports use of budesonide in chronic asthma. Consensus guidelines for chronic asthma suggest titrating inhaled steroid dose to individual requirements. Evidence from this review of trials does not present a case for routine dose titration above 800 mcg/d.

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Plain language summary

available in

Budesonide versus placebo for asthma

Budesonide is highly effective preventative treatment for all patients with asthma, irrespective of age or severity of their disease. Most benefits are seen with low‐moderate doses.