Gabriel Bolner, Yohanna Idsabella Rossi, Jonathan Costa Dall'Acqua, Artur Vestena Rossato, Fabiana Dolovitsch de Oliveira, Kauê Bolner, Gilberto Bueno Fischer, Janice Luisa Lukrafka, Helena Teresinha Mocelin
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引用次数: 0
Abstract
Introduction: Children under 12 have fewer treatment options for uncontrolled asthma than adolescents and adults. Long-acting muscarinic antagonists (LAMA) can be used as an add-on therapy for asthma in adults, but the evidence in children is unclear.
Methods: We systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) and observational studies that evaluated LAMA as an add-on therapy to inhaled corticosteroids in asthmatic children younger than 12. We performed a random-effects meta-analysis for lung function, asthma control, and adverse events. Subgroup analyses were performed for different LAMA dosages.
Results: Four RCTs and two observational studies (n = 1210) were included in our systematic review. The pulmonary function tests indicated that LAMA at any dose significantly improved peak FEV1 (MD 86.16 mL; 95 %CI 18.62-153.71; p < 0.01) and FEF25-75 % (MD 0.2518L; 95 %CI 0.1971-0.3064; p < 0.01), while FVC (MD 9.69 mL; 95 %CI -34.57 to 53.95; p = 0.67) remained unchanged. Asthma control measured by the Asthma Control Questionnaire (MD -0.07; 95 %CI -0.08 to -0.06; p < 0.01) also favoured LAMA treatments. Nighttime awakenings and rescue treatment usage showed no significant differences between groups. Using LAMA was also associated with fewer adverse events (RR 0.88; 95 %CI 0.79-0.98; p = 0.021).
Conclusion: LAMA are safe and effective for moderate/severe asthma for children aged 6-11. Evidence is still slowly evolving for children younger than 6 years.
期刊介绍:
Paediatric Respiratory Reviews offers authors the opportunity to submit their own editorials, educational reviews and short communications on topics relevant to paediatric respiratory medicine. These peer reviewed contributions will complement the commissioned reviews which will continue to form an integral part of the journal.
Subjects covered include:
• Epidemiology
• Immunology and cell biology
• Physiology
• Occupational disorders
• The role of allergens and pollutants
A particular emphasis is given to the recommendation of "best practice" for primary care physicians and paediatricians.
Paediatric Respiratory Reviews is aimed at general paediatricians but it should also be read by specialist paediatric physicians and nurses, respiratory physicians and general practitioners.
It is a journal for those who are busy and do not have time to read systematically through literature, but who need to stay up to date in the field of paediatric respiratory and sleep medicine.