EFFECTIVENESS OF PROPHYLACTIC INHALED STEROIDS IN CHILDHOOD ASTHMA - A SYSTEMATIC REVIEW OF THE LITERATURE

Background: There has been no systematic appraisal of the evidence reg arding the effectiveness of prophylactic inhaled steroids in childhood asthma, Objective: We sought to evaluate the effectiveness of prophyl actic inhaled steroids in childhood asthma. Methods: A MEDLINE search from January-1966 through December 1996 was used to identify pertinent English-language publications, All randomized, double-blind, placebo- controlled trials of prophylactic inhaled steroid therapy for childhoo d asthma that included data on clinical outcomes (symptom scores and c oncomitant drug use) or laboratory outcomes (peak expiratory how rate) were included. Results: In total, 24 of 93 studies retrieved met the inclusion criteria, The overall weighted relative improvement in mean total symptom score (inhaled steroid vs placebo) was 50% (95% confiden ce interval [CI]: 49%, 51%), the overall weighted relative decrease in mean concomitant beta(2)-agonist use (inhaled steroid vs placebo) was 37% (95% CI: 36%, 38%), and the overall weighted relative decrease in mean concomitant oral steroid use (inhaled steroid vs placebo) was 68 % (95% CI: 66%, 70%). The overall weighted absolute improvement in mea n peak expiratory flow rate (inhaled steroid vs placebo) was 38 L/min (95% CI: 34.3 L/min, 41.7 L/min). Conclusions: Prophylactic inhaled st eroids are effective, compared with placebo, in improving both clinica l and laboratory outcomes in childhood asthma.