Should we Substitute Intermittent for Maintenance Inhaled Corticosteroids in Patients with Persistent Asthma? A Systematic Review and Meta-Analysis
Bibliographic record
Abstract
Background: Although guidelines recommend maintenance inhaled corticosteroids (ICS) in mild persistent asthma, most patients use, and many physicians prescribe, intermittent ICS.Objective: To compare the efficacy and safety of maintenance versus intermittent ICS in children and adults with persistent asthma and to explore potential effect modifiers attributable to either strategy. Methods:We searched the literature using: the Cochrane airways group specialized register of trials and ClinicalTrials.govwebsite until October 2012.All randomized controlled trials, at least of four-week duration, comparing maintenance and intermittent ICS initiated at the onset of exacerbations.The primary efficacy and safety outcomes were the risk of patients with exacerbations requiring rescue oral corticosteroids and serious adverse events, respectively.Secondary outcomes included exacerbations, asthma control, lung function, airway inflammation, withdrawals, and adverse events.Results: Six (4 pediatric; 2 adult) trials involving 1211 patients with mild persistent asthma met the eligibility criteria; they lasted 12-52 weeks.There was no statistically significant group difference in the risk of patients with exacerbations requiring rescue oral corticosteroids (RR 1.07; 95% CI 0.87, 1.32).The response magnitude was not influenced by age, asthma severity, step-up protocol, and intervention duration.Maintenance ICS was superior to intermittent ICS in several indicators of symptoms, ß2-agonist use, lung function, and airway inflammation.There was no group difference in the risk of patients with serious adverse events (RR=0.82;95% CI 0.33, 2.03).In children, maintenance ICS was associated with less linear growth (MD=0.4195% CI 0.13, 0.69) over 44-52 weeks.Conclusions: In children and adults with persistent asthma, maintenance and intermittent ICS strategies did not significantly differ in the risk of patients experiencing exacerbations requiring rescue oral corticosteroids and severe adverse events; however the wide confidence interval precludes equivalence.Maintenance ICS was superior to intermittent ICS in several indicators of lung function, airway inflammation, asthma control and reliever use.The paucity of trials prevents firm conclusions.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.023 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.018 |
| Bibliometrics | 0.002 | 0.003 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".