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Abstract: Slide Presentations |

EFFECTS OF LONG ACTING BRONCHODILATORS VERSUS LEUKOTRIENE MODIFIERS AS ADD-ON THERAPY TO INHALED CORTICOSTEROIDS IN ASTHMA: A SYSTEMATIC REVIEW FREE TO VIEW

Graeme P. Currie, MD*; Daniel K. Lee, MD; Prasima Srivastava, MD
Author and Funding Information

Aberdeen Royal Infirmary, Aberdeen, United Kingdom


Chest


Chest. 2005;128(4_MeetingAbstracts):164S. doi:10.1378/chest.128.4.2954
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Abstract

PURPOSE:  Despite the widespread use of inhaled corticosteroids, many asthmatic patients experience persistent symptoms. The main alternatives to increasing the inhaled corticosteroid dose are either adding a long acting β2 agonist (LABA) or leukotriene receptor antagonist (LTRA).

METHODS:  We performed a comprehensive literature search to highlight the results of all randomised placebo-controlled trials where head-to-head comparisons of both treatments were made in patients using inhaled corticosteroids. We examined their relative effects upon exacerbations, lung function, inflammatory biomarkers and symptoms.

RESULTS:  Nine trials were identified which evaluated the effects of LTRAs versus LABAs as add-on therapy to inhaled corticosteroids. Six trials evaluated effects upon exacerbations. In four of these - including the two of longest duration and greatest number of patients - no significant differences were observed between randomised treatments. In most trials (n=8), the addition of a LABA conferred superiority over add-on LTRA in terms of lung function. In the four trials which evaluated effects of treatment upon inflammatory biomarkers, add-on LTRA was significantly superior to LABA. In most trials (n=5) no significant differences were observed between add-on LABA or LTRA in terms of symptoms or quality of life.

CONCLUSION:  The addition of a LTRA to an inhaled corticosteroid was generally as effective at reducing exacerbations as adding in a LABA. The addition of a LABA was consistently superior to a LTRA in improving lung function, while the latter treatment conferred significant anti-inflammatory effects to a greater extent.

CLINICAL IMPLICATIONS:  In symptomatic asthmatics with impaired airway calibre receiving inhaled corticosteroids, the addition of a LABA would appear appropriate. In those persistent asthmatics with normal airway calibre receiving inhaled corticosteroids, the addition of a LTRA would appear logical in order to attenuate the underlying inflammatory process and relieve symptoms.

DISCLOSURE:  Graeme Currie, None.

Tuesday, November 1, 2005

10:30 AM - 12:00 PM


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