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Chloroquine as a steroid sparing agent for asthma

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Abstract

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Background

For the majority of chronic asthmatics, symptoms are best controlled using inhaled steroids, but for a small group of asthma sufferers, symptoms cannot be controlled using inhaled steroids and instead continuous use of high dosage oral steroids (corticosteroids) are required. However, using high dosage oral steroids for long periods is associated with severe side effects. Steroid‐sparing treatments have been sought and one of these is chloroquine. Chloroquine is an anti‐inflammatory agent, also used in the treatment of malarial infection and as a second‐line therapy in the treatment of rheumatoid arthritis, sarcoidosis and systemic lupus erythematosus. All these diseases are associated with immunologic abnormalities hence the speculation that chloroquine might be used to control severe, poorly controlled bronchial asthma. There is a need to systematically evaluate the evidence regarding its use to reduce or eliminate oral corticosteroid use in asthma.

Objectives

The object of this review was to assess the efficacy of adding chloroquine to oral corticosteroids in patients with chronic asthma who are dependent on oral corticosteroids with the intention of minimising or eventually eliminating the use of these oral steroids.

Search methods

Searches of the Cochrane Airways Group Specialised Register were undertaken with predefined search terms. Searches are current as of February 2011.

Selection criteria

Only studies with a randomised placebo‐controlled design met the inclusion criteria for the review.

Data collection and analysis

Two reviewers independently assessed studies for suitable in the review. Data were extracted and entered into RevMan 5.

Main results

One small study was included in the review. No significant findings were reported. An update search conducted in February 2007 did not identify any new studies.

Authors' conclusions

There is insufficient evidence to support the use of chloroquine as an oral steroid‐sparing agent in chronic asthma. Further trials should optimise oral steroid dosage before addition of the steroid‐sparing agent.

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

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Chloroquine as a steroid sparing agent for asthma

Asthma can be treated with drugs which aim to reduce inflammation in the airways. Inhaled corticosteroids are frequently used, but occasionally individuals require oral steroids for adequate control. However, oral steroids are frequently associated with severe side‐effects. Chloroquine has been suggested as a useful 'add‐on' therapy to oral steroid treatment with the aim of reducing the dose requirement in such asthma. This review found one small cross‐over study but this did not provide adequate evidence to decide whether chloroquine should be offered to reduce or eliminate oral steroid treatment. There is a need for well‐designed trials addressing this question before recommendations can be made.