Scolaris Content Display Scolaris Content Display

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Forest plot of comparison: 1 Intermittent 'as needed' ICS versus daily ICS, outcome: 1.1 Patients with 1 or more exacerbations requiring oral corticosteroids.
Figuras y tablas -
Figure 3

Forest plot of comparison: 1 Intermittent 'as needed' ICS versus daily ICS, outcome: 1.1 Patients with 1 or more exacerbations requiring oral corticosteroids.

Funnel plot of comparison: 1 Intermittent 'as needed' ICS versus daily ICS, outcome: 1.1 Patients with 1 or more exacerbations requiring oral corticosteroids.
Figuras y tablas -
Figure 4

Funnel plot of comparison: 1 Intermittent 'as needed' ICS versus daily ICS, outcome: 1.1 Patients with 1 or more exacerbations requiring oral corticosteroids.

Forest plot of comparison: 1 Intermittent 'as needed' ICS versus daily ICS, outcome: 1.2 Patients with serious adverse health events.
Figuras y tablas -
Figure 5

Forest plot of comparison: 1 Intermittent 'as needed' ICS versus daily ICS, outcome: 1.2 Patients with serious adverse health events.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 1 Patients with 1 or more exacerbations requiring oral corticosteroids.
Figuras y tablas -
Analysis 1.1

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 1 Patients with 1 or more exacerbations requiring oral corticosteroids.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 2 Exacerbations requiring oral corticosteroids: subgroup analysis for age.
Figuras y tablas -
Analysis 1.2

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 2 Exacerbations requiring oral corticosteroids: subgroup analysis for age.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 3 Exacerbations requiring oral corticosteroids: subgroup analysis for duration of treatment.
Figuras y tablas -
Analysis 1.3

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 3 Exacerbations requiring oral corticosteroids: subgroup analysis for duration of treatment.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 4 Exacerbations requiring oral corticosteroids: subgroup analysis for severity of airway obstruction.
Figuras y tablas -
Analysis 1.4

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 4 Exacerbations requiring oral corticosteroids: subgroup analysis for severity of airway obstruction.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 5 Patients with serious adverse health events.
Figuras y tablas -
Analysis 1.5

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 5 Patients with serious adverse health events.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 6 Patients with at least 1 exacerbation requiring emergency department/acute care visit.
Figuras y tablas -
Analysis 1.6

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 6 Patients with at least 1 exacerbation requiring emergency department/acute care visit.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 7 Patients with at least 1 exacerbation requiring hospital admission.
Figuras y tablas -
Analysis 1.7

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 7 Patients with at least 1 exacerbation requiring hospital admission.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 8 Number of exacerbations requiring emergency department visits.
Figuras y tablas -
Analysis 1.8

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 8 Number of exacerbations requiring emergency department visits.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 9 Time to exacerbation requiring oral corticosteroids.
Figuras y tablas -
Analysis 1.9

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 9 Time to exacerbation requiring oral corticosteroids.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 10 Change from baseline AM PEFR (%).
Figuras y tablas -
Analysis 1.10

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 10 Change from baseline AM PEFR (%).

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 11 Change from baseline AM PEFR (L/min).
Figuras y tablas -
Analysis 1.11

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 11 Change from baseline AM PEFR (L/min).

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 12 Change from baseline FEV1 (%).
Figuras y tablas -
Analysis 1.12

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 12 Change from baseline FEV1 (%).

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 13 Change from baseline FEV1 (L).
Figuras y tablas -
Analysis 1.13

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 13 Change from baseline FEV1 (L).

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 14 Change from baseline mean diurnal variation in PEFR.
Figuras y tablas -
Analysis 1.14

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 14 Change from baseline mean diurnal variation in PEFR.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 15 Change in PC20.
Figuras y tablas -
Analysis 1.15

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 15 Change in PC20.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 16 Change from baseline in asthma control days.
Figuras y tablas -
Analysis 1.16

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 16 Change from baseline in asthma control days.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 17 Proportion of asthma control days over the period.
Figuras y tablas -
Analysis 1.17

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 17 Proportion of asthma control days over the period.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 18 Change from baseline mean daily use of β2‐agonists (puffs/day).
Figuras y tablas -
Analysis 1.18

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 18 Change from baseline mean daily use of β2‐agonists (puffs/day).

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 19 Cumulative dose of rescue albuterol (μg) over the period.
Figuras y tablas -
Analysis 1.19

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 19 Cumulative dose of rescue albuterol (μg) over the period.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 20 Change from baseline in daytime symptom scores.
Figuras y tablas -
Analysis 1.20

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 20 Change from baseline in daytime symptom scores.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 21 Change from baseline in asthma symptoms utility index.
Figuras y tablas -
Analysis 1.21

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 21 Change from baseline in asthma symptoms utility index.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 22 Change in proportion of 'symptom‐free days'.
Figuras y tablas -
Analysis 1.22

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 22 Change in proportion of 'symptom‐free days'.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 23 Change from baseline in night‐time awakenings.
Figuras y tablas -
Analysis 1.23

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 23 Change from baseline in night‐time awakenings.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 24 Change from baseline in quality of life (QoL).
Figuras y tablas -
Analysis 1.24

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 24 Change from baseline in quality of life (QoL).

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 25 Days with use of β2‐agonists (%).
Figuras y tablas -
Analysis 1.25

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 25 Days with use of β2‐agonists (%).

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 26 Change in exhaled nitric oxide (ppb).
Figuras y tablas -
Analysis 1.26

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 26 Change in exhaled nitric oxide (ppb).

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 27 Change in height (cm).
Figuras y tablas -
Analysis 1.27

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 27 Change in height (cm).

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 28 Change in height (Z‐score).
Figuras y tablas -
Analysis 1.28

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 28 Change in height (Z‐score).

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 29 Change in weight (Z‐score).
Figuras y tablas -
Analysis 1.29

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 29 Change in weight (Z‐score).

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 30 Change in weight (kg).
Figuras y tablas -
Analysis 1.30

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 30 Change in weight (kg).

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 31 Salivary cortisol level.
Figuras y tablas -
Analysis 1.31

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 31 Salivary cortisol level.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 32 Overall withdrawals.
Figuras y tablas -
Analysis 1.32

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 32 Overall withdrawals.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 33 Oral candidiasis.
Figuras y tablas -
Analysis 1.33

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 33 Oral candidiasis.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 34 Withdrawal owing to adverse events.
Figuras y tablas -
Analysis 1.34

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 34 Withdrawal owing to adverse events.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 35 Cumulative dose of ICS over the period (μg beclomethasone equivalent).
Figuras y tablas -
Analysis 1.35

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 35 Cumulative dose of ICS over the period (μg beclomethasone equivalent).

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 36 Overall adverse effects.
Figuras y tablas -
Analysis 1.36

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 36 Overall adverse effects.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 37 Withdrawal owing to poor asthma control/exacerbations.
Figuras y tablas -
Analysis 1.37

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 37 Withdrawal owing to poor asthma control/exacerbations.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 38 Pneumonia.
Figuras y tablas -
Analysis 1.38

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 38 Pneumonia.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 39 Nausea.
Figuras y tablas -
Analysis 1.39

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 39 Nausea.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 40 Headache.
Figuras y tablas -
Analysis 1.40

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 40 Headache.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 41 Upper respiratory tract infections.
Figuras y tablas -
Analysis 1.41

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 41 Upper respiratory tract infections.

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 42 Death.
Figuras y tablas -
Analysis 1.42

Comparison 1 Intermittent 'as needed' ICS versus daily ICS, Outcome 42 Death.

Summary of findings for the main comparison. Intermittent 'as needed' ICS versus daily ICS for persistent asthma in children and adults

Intermittent 'as needed' ICS versus daily ICS for persistent asthma in children and adults

Patient or population: patients with persistent asthma in children and adults
Settings: outpatients
Intervention: intermittent 'as needed' ICS versus daily ICS

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Daily ICS

Intermittent ICS

Patients with 1 or more exacerbations requiring oral corticosteroids

(duration 12 to 52 weeks)

19 per 100

20 (17 to 25) per 100

RR 1.07
(0.87 to 1.32)

1204
(7 studies)

⊕⊕⊝⊝
low1,2

Patients with at least 1 exacerbation requiring emergency department/acute care visit

(duration 12 to 52 weeks)

15 per 100

18 (14 to 20) per 100

RR 1.08
(0.9 to 1.3)

1055
(6 studies)

⊕⊕⊝⊝
low1,2

Change from baseline AM PEFR (%)

(duration 44 to 52 weeks)

The mean change from baseline am PEFR (%) in the intermittent groups was 2.56% lower than daily ICS group
(4.49 to 0.63 lower)

MD ‐2.56

(‐4.49 to ‐0.63)

350
(3 studies)

⊕⊕⊕⊝
moderate2

Proportion of asthma control days over the period

(duration 44 to 52 weeks)

The mean proportion of asthma control days over the period in the intermittent groups was 9% lower than daily ICS group (4% to 14%)

MD ‐0.09

(‐0.14 to ‐0.04)

330
(3 studies)

⊕⊕⊕⊝
moderate2

Change from baseline mean daily use of β2‐agonists (puffs/day)

(duration 24 to 44 weeks)

The mean change from baseline mean daily use of β2‐agonists (puffs/day) in the intermittent groups was 0.12 puffs/day higher than daily ICS group
(0 to 0.23 higher)

MD 0.12

(0.00 to 0.23)

442
(3 studies)

⊕⊕⊕⊝

moderate2

Change in height (cm)

(duration 44 to 52 weeks)

The mean change in height (cm) in the intermittent groups was 0.41 cm higher than daily ICS group (0.13 to 0.69 higher)

MD 0.41 (0.13 to 0.69)

532
(4 studies)

⊕⊕⊕⊝
moderate2

Overall withdrawals

(duration 12 to 52 weeks)

14 per 100

14 (11 to 19) per 100

OR 1.05
(0.75 to 1.46)

1210
(7 studies)

⊕⊕⊝⊝
low1,2

*The basis for the assumed risk was the mean control group risk across studies. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect (and its 95% CI).
CI: confidence interval; ICS: inhaled corticosteroid; MD: mean difference; OR: odds ratio; PEFR: peak expiratory flow rate; RR: risk ratio.

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1. Confidence intervals were too wide to exclude important differences between treatments for this outcome.

2. Diversity of ways in which intermittent ICS regimens were implemented and the variety of participants in the trials limits the confidence in our estimate of the treatment effects

Figuras y tablas -
Summary of findings for the main comparison. Intermittent 'as needed' ICS versus daily ICS for persistent asthma in children and adults
Comparison 1. Intermittent 'as needed' ICS versus daily ICS

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Patients with 1 or more exacerbations requiring oral corticosteroids Show forest plot

7

1204

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.87, 1.32]

1.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

2

264

Risk Ratio (M‐H, Fixed, 95% CI)

0.96 [0.44, 2.13]

1.2 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

278

Risk Ratio (M‐H, Fixed, 95% CI)

1.03 [0.80, 1.34]

1.3 'As needed' ICS+β2‐agonist use during exacerbations in both groups

1

107

Risk Ratio (M‐H, Fixed, 95% CI)

1.17 [0.67, 2.03]

1.4 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

3

555

Risk Ratio (M‐H, Fixed, 95% CI)

1.20 [0.71, 2.04]

2 Exacerbations requiring oral corticosteroids: subgroup analysis for age Show forest plot

7

1204

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.87, 1.32]

2.1 Preschool children

2

498

Risk Ratio (M‐H, Fixed, 95% CI)

1.09 [0.85, 1.41]

2.2 School‐aged children

3

329

Risk Ratio (M‐H, Fixed, 95% CI)

1.26 [0.84, 1.88]

2.3 Adults

2

377

Risk Ratio (M‐H, Fixed, 95% CI)

0.60 [0.26, 1.34]

3 Exacerbations requiring oral corticosteroids: subgroup analysis for duration of treatment Show forest plot

7

1204

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.87, 1.32]

3.1 12 to 24 weeks

2

448

Risk Ratio (M‐H, Fixed, 95% CI)

1.13 [0.37, 3.39]

3.2 44 to 52 weeks

5

756

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.87, 1.32]

4 Exacerbations requiring oral corticosteroids: subgroup analysis for severity of airway obstruction Show forest plot

7

1204

Risk Ratio (M‐H, Fixed, 95% CI)

1.07 [0.87, 1.32]

4.1 Mild airway obstruction

6

1089

Risk Ratio (M‐H, Fixed, 95% CI)

1.06 [0.86, 1.30]

4.2 Moderate airway obstruction

1

115

Risk Ratio (M‐H, Fixed, 95% CI)

2.95 [0.32, 27.51]

5 Patients with serious adverse health events Show forest plot

6

1055

Risk Ratio (M‐H, Fixed, 95% CI)

0.82 [0.33, 2.03]

5.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

1

115

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.04, 3.06]

5.2 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

278

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.34, 4.56]

5.3 'As needed' ICS+β2‐agonist use during exacerbations in both groups

1

107

Risk Ratio (M‐H, Fixed, 95% CI)

0.65 [0.03, 15.53]

5.4 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

3

555

Risk Ratio (M‐H, Fixed, 95% CI)

0.78 [0.10, 6.22]

6 Patients with at least 1 exacerbation requiring emergency department/acute care visit Show forest plot

6

1055

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.90, 1.30]

6.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

1

115

Risk Ratio (M‐H, Fixed, 95% CI)

0.98 [0.06, 15.34]

6.2 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

278

Risk Ratio (M‐H, Fixed, 95% CI)

1.08 [0.90, 1.30]

6.3 'As needed' ICS+β2‐agonist use during exacerbations in both groups

1

107

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

6.4 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

3

555

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7 Patients with at least 1 exacerbation requiring hospital admission Show forest plot

7

1204

Risk Ratio (M‐H, Fixed, 95% CI)

0.85 [0.29, 2.49]

7.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

2

264

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.04, 3.06]

7.2 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

278

Risk Ratio (M‐H, Fixed, 95% CI)

1.25 [0.34, 4.56]

7.3 'As needed' ICS+β2‐agonist use during exacerbations in both groups

1

107

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

7.4 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

3

555

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Number of exacerbations requiring emergency department visits Show forest plot

2

264

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.14, 3.44]

8.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

2

264

Risk Ratio (M‐H, Fixed, 95% CI)

0.69 [0.14, 3.44]

9 Time to exacerbation requiring oral corticosteroids Show forest plot

3

Hazard Ratio (Random, 95% CI)

0.88 [0.55, 1.40]

9.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

Hazard Ratio (Random, 95% CI)

0.97 [0.68, 1.38]

9.2 'As needed' ICS+β2‐agonist use during exacerbations in both groups

1

Hazard Ratio (Random, 95% CI)

0.60 [0.36, 1.01]

9.3 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

1

Hazard Ratio (Random, 95% CI)

1.93 [0.55, 6.76]

10 Change from baseline AM PEFR (%) Show forest plot

3

350

Mean Difference (IV, Fixed, 95% CI)

‐2.56 [‐4.49, ‐0.63]

10.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

1

136

Mean Difference (IV, Fixed, 95% CI)

‐1.20 [‐6.61, 4.21]

10.2 'As needed' ICS+β2‐agonist use during exacerbations in both groups

1

107

Mean Difference (IV, Fixed, 95% CI)

‐2.42 [‐5.34, 0.50]

10.3 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

1

107

Mean Difference (IV, Fixed, 95% CI)

‐3.10 [‐6.02, ‐0.18]

11 Change from baseline AM PEFR (L/min) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

11.1 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

12 Change from baseline FEV1 (%) Show forest plot

2

365

Mean Difference (IV, Random, 95% CI)

‐0.49 [‐5.82, 4.84]

12.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

1

137

Mean Difference (IV, Random, 95% CI)

‐3.3 [‐6.49, ‐0.11]

12.2 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

1

228

Mean Difference (IV, Random, 95% CI)

2.14 [‐0.40, 4.68]

13 Change from baseline FEV1 (L) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

13.1 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

14 Change from baseline mean diurnal variation in PEFR Show forest plot

3

442

Mean Difference (IV, Fixed, 95% CI)

0.02 [‐0.71, 0.76]

14.1 'As needed' ICS+β2‐agonist use during exacerbations in both groups

1

107

Mean Difference (IV, Fixed, 95% CI)

‐0.14 [‐1.42, 1.14]

14.2 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

2

335

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.79, 1.00]

15 Change in PC20 Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

15.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

16 Change from baseline in asthma control days Show forest plot

2

214

Mean Difference (IV, Fixed, 95% CI)

‐0.07 [‐0.14, ‐0.01]

16.1 'As needed' ICS+β2‐agonist use during exacerbations in both groups

1

107

Mean Difference (IV, Fixed, 95% CI)

‐0.06 [‐0.15, 0.04]

16.2 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

1

107

Mean Difference (IV, Fixed, 95% CI)

‐0.09 [‐0.18, 0.01]

17 Proportion of asthma control days over the period Show forest plot

3

330

Mean Difference (IV, Fixed, 95% CI)

‐0.09 [‐0.14, ‐0.04]

17.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

1

116

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

17.2 'As needed' ICS+β2‐agonist use during exacerbations in both groups

1

107

Mean Difference (IV, Fixed, 95% CI)

‐0.09 [‐0.16, ‐0.02]

17.3 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

1

107

Mean Difference (IV, Fixed, 95% CI)

‐0.09 [‐0.16, ‐0.02]

18 Change from baseline mean daily use of β2‐agonists (puffs/day) Show forest plot

3

442

Mean Difference (IV, Fixed, 95% CI)

0.12 [0.00, 0.23]

18.1 'As needed' ICS+β2‐agonist use during exacerbations in both groups

1

107

Mean Difference (IV, Fixed, 95% CI)

0.15 [‐0.05, 0.35]

18.2 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

2

335

Mean Difference (IV, Fixed, 95% CI)

0.10 [‐0.04, 0.24]

19 Cumulative dose of rescue albuterol (μg) over the period Show forest plot

2

214

Mean Difference (IV, Fixed, 95% CI)

51.47 [11.36, 91.57]

19.1 'As needed' ICS+β2‐agonist use during exacerbations in both groups

1

107

Mean Difference (IV, Fixed, 95% CI)

59.30 [4.83, 113.77]

19.2 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

1

107

Mean Difference (IV, Fixed, 95% CI)

42.2 [‐17.06, 101.46]

20 Change from baseline in daytime symptom scores Show forest plot

3

591

Std. Mean Difference (IV, Fixed, 95% CI)

0.13 [‐0.04, 0.29]

20.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

1

143

Std. Mean Difference (IV, Fixed, 95% CI)

0.15 [‐0.18, 0.48]

20.2 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

2

448

Std. Mean Difference (IV, Fixed, 95% CI)

0.12 [‐0.07, 0.30]

21 Change from baseline in asthma symptoms utility index Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

21.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

22 Change in proportion of 'symptom‐free days' Show forest plot

5

984

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.15 [‐0.28, ‐0.03]

22.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

2

258

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.32 [‐0.57, ‐0.07]

22.2 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

278

Std. Mean Difference (IV, Fixed, 95% CI)

0.0 [‐0.24, 0.24]

22.3 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

2

448

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.15 [‐0.34, 0.03]

23 Change from baseline in night‐time awakenings Show forest plot

2

448

Mean Difference (IV, Fixed, 95% CI)

‐0.03 [‐0.08, 0.02]

23.1 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

2

448

Mean Difference (IV, Fixed, 95% CI)

‐0.03 [‐0.08, 0.02]

24 Change from baseline in quality of life (QoL) Show forest plot

2

389

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.16 [‐0.36, 0.04]

24.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

1

137

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.24 [‐0.58, 0.10]

24.2 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

252

Std. Mean Difference (IV, Fixed, 95% CI)

‐0.11 [‐0.36, 0.14]

25 Days with use of β2‐agonists (%) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

25.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

26 Change in exhaled nitric oxide (ppb) Show forest plot

2

214

Mean Difference (IV, Fixed, 95% CI)

16.80 [11.95, 21.64]

26.1 'As needed' ICS+β2‐agonist use during exacerbations in both groups

1

107

Mean Difference (IV, Fixed, 95% CI)

18.16 [11.09, 25.23]

26.2 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

1

107

Mean Difference (IV, Fixed, 95% CI)

15.59 [8.94, 22.24]

27 Change in height (cm) Show forest plot

4

532

Mean Difference (IV, Fixed, 95% CI)

0.41 [0.13, 0.69]

27.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

1

95

Mean Difference (IV, Fixed, 95% CI)

0.61 [0.12, 1.10]

27.2 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

223

Mean Difference (IV, Fixed, 95% CI)

0.25 [‐0.17, 0.67]

27.3 'As needed' ICS+β2‐agonist use during exacerbations in both groups

1

107

Mean Difference (IV, Fixed, 95% CI)

0.46 [‐0.37, 1.29]

27.4 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

1

107

Mean Difference (IV, Fixed, 95% CI)

0.40 [‐0.43, 1.23]

28 Change in height (Z‐score) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

28.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

29 Change in weight (Z‐score) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

29.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

30 Change in weight (kg) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

30.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

31 Salivary cortisol level Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

31.1 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

32 Overall withdrawals Show forest plot

7

1210

Odds Ratio (M‐H, Fixed, 95% CI)

1.05 [0.75, 1.46]

32.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

2

264

Odds Ratio (M‐H, Fixed, 95% CI)

1.54 [0.71, 3.34]

32.2 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

278

Odds Ratio (M‐H, Fixed, 95% CI)

0.59 [0.34, 1.04]

32.3 'As needed' ICS+β2‐agonist use during exacerbations in both groups

1

107

Odds Ratio (M‐H, Fixed, 95% CI)

1.90 [0.63, 5.74]

32.4 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

3

561

Odds Ratio (M‐H, Fixed, 95% CI)

1.32 [0.75, 2.30]

33 Oral candidiasis Show forest plot

2

343

Odds Ratio (M‐H, Fixed, 95% CI)

0.30 [0.03, 2.95]

33.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

1

115

Odds Ratio (M‐H, Fixed, 95% CI)

0.32 [0.01, 8.07]

33.2 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

1

228

Odds Ratio (M‐H, Fixed, 95% CI)

0.29 [0.01, 7.12]

34 Withdrawal owing to adverse events Show forest plot

6

1063

Odds Ratio (M‐H, Fixed, 95% CI)

0.78 [0.21, 2.93]

34.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

1

117

Odds Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 8.35]

34.2 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

278

Odds Ratio (M‐H, Fixed, 95% CI)

0.20 [0.01, 4.14]

34.3 'As needed' ICS+β2‐agonist use during exacerbations in both groups

1

107

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

34.4 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

3

561

Odds Ratio (M‐H, Fixed, 95% CI)

2.85 [0.29, 27.61]

35 Cumulative dose of ICS over the period (μg beclomethasone equivalent) Show forest plot

2

213

Mean Difference (IV, Random, 95% CI)

‐16334.36 [‐19189.04, ‐13479.69]

35.1 'As needed' ICS+β2‐agonist use during exacerbations in both groups

1

107

Mean Difference (IV, Random, 95% CI)

‐17787.0 [‐20164.04, ‐15409.96]

35.2 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

1

106

Mean Difference (IV, Random, 95% CI)

‐14874.0 [‐17269.16, ‐12478.84]

36 Overall adverse effects Show forest plot

3

726

Odds Ratio (M‐H, Fixed, 95% CI)

1.01 [0.70, 1.44]

36.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

278

Odds Ratio (M‐H, Fixed, 95% CI)

0.94 [0.46, 1.90]

36.2 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

2

448

Odds Ratio (M‐H, Fixed, 95% CI)

1.03 [0.68, 1.57]

37 Withdrawal owing to poor asthma control/exacerbations Show forest plot

6

1063

Odds Ratio (M‐H, Random, 95% CI)

1.66 [0.54, 5.13]

37.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

1

117

Odds Ratio (M‐H, Random, 95% CI)

3.43 [0.88, 13.38]

37.2 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

278

Odds Ratio (M‐H, Random, 95% CI)

0.28 [0.08, 1.06]

37.3 'As needed' ICS+β2‐agonist use during exacerbations in both groups

1

107

Odds Ratio (M‐H, Random, 95% CI)

2.70 [0.68, 10.76]

37.4 'As needed' ICS+β2‐agonist use during exacerbations in intermittent group only

3

561

Odds Ratio (M‐H, Random, 95% CI)

2.44 [0.39, 15.41]

38 Pneumonia Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

38.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

39 Nausea Show forest plot

2

393

Odds Ratio (M‐H, Fixed, 95% CI)

1.16 [0.54, 2.51]

39.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

1

115

Odds Ratio (M‐H, Fixed, 95% CI)

0.98 [0.23, 4.13]

39.2 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

278

Odds Ratio (M‐H, Fixed, 95% CI)

1.24 [0.50, 3.10]

40 Headache Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

40.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

41 Upper respiratory tract infections Show forest plot

2

393

Odds Ratio (M‐H, Fixed, 95% CI)

1.47 [0.89, 2.43]

41.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

1

115

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

41.2 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

278

Odds Ratio (M‐H, Fixed, 95% CI)

1.47 [0.89, 2.43]

42 Death Show forest plot

2

393

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

42.1 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in both groups

1

115

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

42.2 Pre‐emptive 4‐fold step‐up ICS dose during exacerbations in intermittent group only

1

278

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 1. Intermittent 'as needed' ICS versus daily ICS