Combination inhaled corticosteroids and long-acting beta2-agonists for children and adults with bronchiectasis

Vikas Goyal, Anne Chang

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Bronchiectasis is a major contributor to chronic respiratory morbidity and mortality worldwide. Wheeze and other asthma-like symptoms and bronchial hyperreactivity may occur in people with bronchiectasis. Physicians often use asthma treatments in patients with bronchiectasis.

Objectives: To assess the effects of inhaled long-acting beta2-agonists (LABA) combined with inhaled corticosteroids (ICS) in children and adults with bronchiectasis during (1) acute exacerbations and (2) stable state.

Search methods: The Cochrane AirwaysGroup searched the the Cochrane AirwaysGroup Specialised Register of Trials, which includes records identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and other databases. The Cochrane Airways Group performed the latest searches in October 2013.

Selection criteria: All randomised controlled trials (RCTs) of combined ICS and LABA compared with a control (placebo, no treatment, ICS asmonotherapy) in children and adults with bronchiectasis not related to cystic fibrosis (CF).

Data collection and analysis: Two reviewauthors extracted data independently using standardmethodological procedures as expected byTheCochraneCollaboration.

Main results: We found no RCTs comparing ICS and LABA combination with either placebo or usual care. We included one RCT that compared combined ICS and LABA with high-dose ICS in 40 adults with non-CF bronchiectasis without co-existent asthma. All participants received three months of high-dose budesonide dipropionate treatment (1600 micrograms). After three months, participants were randomly assigned to receive either high-dose budesonide dipropionate (1600 micrograms per day) or a combination of budesonide with formoterol (640 micrograms of budesonide and 18 micrograms of formoterol) for three months. The study was not blinded. We assessed it to be an RCT with overall high risk of bias. Data analysed in this review showed that those who received combined ICS-LABA (in stable state) had a significantly better transition dyspnoea index (mean difference (MD) 1.29, 95% confidence interval (CI) 0.40 to 2.18) and cough-free days (MD 12.30, 95% CI 2.38 to 22.2) compared with those receiving ICS after three months of treatment. No significant difference was noted between groups in quality of life (MD -4.57, 95% CI -12.38 to 3.24), number of hospitalisations (odds ratio (OR) 0.26, 95% CI 0.02 to 2.79) or lung function (forced expiratory volume in one second (FEV1) and forced vital capacity (FVC)). Investigators reported 37 adverse events in the ICS group versus 12 events in the ICS-LABA group but
did not mention the number of individuals experiencing adverse events. Hence differences between groups were not included in the analyses. We assessed the overall evidence to be low quality.

Authors' conclusions: In adults with bronchiectasis without co-existent asthma, during stable state, a small single trial with a high risk of bias suggests that combined ICS-LABA may improve dyspnoea and increase cough-free days in comparison with high-dose ICS. No data are provided for or against, the use of combined ICS-LABA in adults with bronchiectasis during an acute exacerbation, or in children with bronchiectasis in a stable or acute state. The absence of high quality evidence means that decisions to use or discontinue combined ICS-LABA in people with bronchiectasis may need to take account of the presence or absence of co-existing airway hyper-responsiveness and consideration of adverse events associated with combined
ICS-LABA.
Original languageEnglish
Article numberCD010327
Pages (from-to)1-24
Number of pages26
JournalCochrane Database of Systematic Reviews
Volume2014
Issue number6
DOIs
Publication statusPublished - 10 Jun 2014

Fingerprint

Bronchiectasis
Adrenal Cortex Hormones
Budesonide
Asthma
Randomized Controlled Trials
Confidence Intervals
Cough
Dyspnea
Respiratory Hypersensitivity
Placebos
Bronchial Hyperreactivity
Vital Capacity
Forced Expiratory Volume
Therapeutics
Cystic Fibrosis
MEDLINE
Patient Selection

Cite this

@article{9e5c0b397ce1420b8038814e113495e1,
title = "Combination inhaled corticosteroids and long-acting beta2-agonists for children and adults with bronchiectasis",
abstract = "Background: Bronchiectasis is a major contributor to chronic respiratory morbidity and mortality worldwide. Wheeze and other asthma-like symptoms and bronchial hyperreactivity may occur in people with bronchiectasis. Physicians often use asthma treatments in patients with bronchiectasis.Objectives: To assess the effects of inhaled long-acting beta2-agonists (LABA) combined with inhaled corticosteroids (ICS) in children and adults with bronchiectasis during (1) acute exacerbations and (2) stable state.Search methods: The Cochrane AirwaysGroup searched the the Cochrane AirwaysGroup Specialised Register of Trials, which includes records identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and other databases. The Cochrane Airways Group performed the latest searches in October 2013.Selection criteria: All randomised controlled trials (RCTs) of combined ICS and LABA compared with a control (placebo, no treatment, ICS asmonotherapy) in children and adults with bronchiectasis not related to cystic fibrosis (CF).Data collection and analysis: Two reviewauthors extracted data independently using standardmethodological procedures as expected byTheCochraneCollaboration.Main results: We found no RCTs comparing ICS and LABA combination with either placebo or usual care. We included one RCT that compared combined ICS and LABA with high-dose ICS in 40 adults with non-CF bronchiectasis without co-existent asthma. All participants received three months of high-dose budesonide dipropionate treatment (1600 micrograms). After three months, participants were randomly assigned to receive either high-dose budesonide dipropionate (1600 micrograms per day) or a combination of budesonide with formoterol (640 micrograms of budesonide and 18 micrograms of formoterol) for three months. The study was not blinded. We assessed it to be an RCT with overall high risk of bias. Data analysed in this review showed that those who received combined ICS-LABA (in stable state) had a significantly better transition dyspnoea index (mean difference (MD) 1.29, 95{\%} confidence interval (CI) 0.40 to 2.18) and cough-free days (MD 12.30, 95{\%} CI 2.38 to 22.2) compared with those receiving ICS after three months of treatment. No significant difference was noted between groups in quality of life (MD -4.57, 95{\%} CI -12.38 to 3.24), number of hospitalisations (odds ratio (OR) 0.26, 95{\%} CI 0.02 to 2.79) or lung function (forced expiratory volume in one second (FEV1) and forced vital capacity (FVC)). Investigators reported 37 adverse events in the ICS group versus 12 events in the ICS-LABA group butdid not mention the number of individuals experiencing adverse events. Hence differences between groups were not included in the analyses. We assessed the overall evidence to be low quality.Authors' conclusions: In adults with bronchiectasis without co-existent asthma, during stable state, a small single trial with a high risk of bias suggests that combined ICS-LABA may improve dyspnoea and increase cough-free days in comparison with high-dose ICS. No data are provided for or against, the use of combined ICS-LABA in adults with bronchiectasis during an acute exacerbation, or in children with bronchiectasis in a stable or acute state. The absence of high quality evidence means that decisions to use or discontinue combined ICS-LABA in people with bronchiectasis may need to take account of the presence or absence of co-existing airway hyper-responsiveness and consideration of adverse events associated with combinedICS-LABA.",
author = "Vikas Goyal and Anne Chang",
year = "2014",
month = "6",
day = "10",
doi = "10.1002/14651858.CD010327.pub2",
language = "English",
volume = "2014",
pages = "1--24",
journal = "Cochrane database of systematic reviews (Online)",
issn = "1469-493X",
publisher = "John Wiley & Sons",
number = "6",

}

Combination inhaled corticosteroids and long-acting beta2-agonists for children and adults with bronchiectasis. / Goyal, Vikas; Chang, Anne.

In: Cochrane Database of Systematic Reviews, Vol. 2014, No. 6, CD010327, 10.06.2014, p. 1-24.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Combination inhaled corticosteroids and long-acting beta2-agonists for children and adults with bronchiectasis

AU - Goyal, Vikas

AU - Chang, Anne

PY - 2014/6/10

Y1 - 2014/6/10

N2 - Background: Bronchiectasis is a major contributor to chronic respiratory morbidity and mortality worldwide. Wheeze and other asthma-like symptoms and bronchial hyperreactivity may occur in people with bronchiectasis. Physicians often use asthma treatments in patients with bronchiectasis.Objectives: To assess the effects of inhaled long-acting beta2-agonists (LABA) combined with inhaled corticosteroids (ICS) in children and adults with bronchiectasis during (1) acute exacerbations and (2) stable state.Search methods: The Cochrane AirwaysGroup searched the the Cochrane AirwaysGroup Specialised Register of Trials, which includes records identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and other databases. The Cochrane Airways Group performed the latest searches in October 2013.Selection criteria: All randomised controlled trials (RCTs) of combined ICS and LABA compared with a control (placebo, no treatment, ICS asmonotherapy) in children and adults with bronchiectasis not related to cystic fibrosis (CF).Data collection and analysis: Two reviewauthors extracted data independently using standardmethodological procedures as expected byTheCochraneCollaboration.Main results: We found no RCTs comparing ICS and LABA combination with either placebo or usual care. We included one RCT that compared combined ICS and LABA with high-dose ICS in 40 adults with non-CF bronchiectasis without co-existent asthma. All participants received three months of high-dose budesonide dipropionate treatment (1600 micrograms). After three months, participants were randomly assigned to receive either high-dose budesonide dipropionate (1600 micrograms per day) or a combination of budesonide with formoterol (640 micrograms of budesonide and 18 micrograms of formoterol) for three months. The study was not blinded. We assessed it to be an RCT with overall high risk of bias. Data analysed in this review showed that those who received combined ICS-LABA (in stable state) had a significantly better transition dyspnoea index (mean difference (MD) 1.29, 95% confidence interval (CI) 0.40 to 2.18) and cough-free days (MD 12.30, 95% CI 2.38 to 22.2) compared with those receiving ICS after three months of treatment. No significant difference was noted between groups in quality of life (MD -4.57, 95% CI -12.38 to 3.24), number of hospitalisations (odds ratio (OR) 0.26, 95% CI 0.02 to 2.79) or lung function (forced expiratory volume in one second (FEV1) and forced vital capacity (FVC)). Investigators reported 37 adverse events in the ICS group versus 12 events in the ICS-LABA group butdid not mention the number of individuals experiencing adverse events. Hence differences between groups were not included in the analyses. We assessed the overall evidence to be low quality.Authors' conclusions: In adults with bronchiectasis without co-existent asthma, during stable state, a small single trial with a high risk of bias suggests that combined ICS-LABA may improve dyspnoea and increase cough-free days in comparison with high-dose ICS. No data are provided for or against, the use of combined ICS-LABA in adults with bronchiectasis during an acute exacerbation, or in children with bronchiectasis in a stable or acute state. The absence of high quality evidence means that decisions to use or discontinue combined ICS-LABA in people with bronchiectasis may need to take account of the presence or absence of co-existing airway hyper-responsiveness and consideration of adverse events associated with combinedICS-LABA.

AB - Background: Bronchiectasis is a major contributor to chronic respiratory morbidity and mortality worldwide. Wheeze and other asthma-like symptoms and bronchial hyperreactivity may occur in people with bronchiectasis. Physicians often use asthma treatments in patients with bronchiectasis.Objectives: To assess the effects of inhaled long-acting beta2-agonists (LABA) combined with inhaled corticosteroids (ICS) in children and adults with bronchiectasis during (1) acute exacerbations and (2) stable state.Search methods: The Cochrane AirwaysGroup searched the the Cochrane AirwaysGroup Specialised Register of Trials, which includes records identified from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and other databases. The Cochrane Airways Group performed the latest searches in October 2013.Selection criteria: All randomised controlled trials (RCTs) of combined ICS and LABA compared with a control (placebo, no treatment, ICS asmonotherapy) in children and adults with bronchiectasis not related to cystic fibrosis (CF).Data collection and analysis: Two reviewauthors extracted data independently using standardmethodological procedures as expected byTheCochraneCollaboration.Main results: We found no RCTs comparing ICS and LABA combination with either placebo or usual care. We included one RCT that compared combined ICS and LABA with high-dose ICS in 40 adults with non-CF bronchiectasis without co-existent asthma. All participants received three months of high-dose budesonide dipropionate treatment (1600 micrograms). After three months, participants were randomly assigned to receive either high-dose budesonide dipropionate (1600 micrograms per day) or a combination of budesonide with formoterol (640 micrograms of budesonide and 18 micrograms of formoterol) for three months. The study was not blinded. We assessed it to be an RCT with overall high risk of bias. Data analysed in this review showed that those who received combined ICS-LABA (in stable state) had a significantly better transition dyspnoea index (mean difference (MD) 1.29, 95% confidence interval (CI) 0.40 to 2.18) and cough-free days (MD 12.30, 95% CI 2.38 to 22.2) compared with those receiving ICS after three months of treatment. No significant difference was noted between groups in quality of life (MD -4.57, 95% CI -12.38 to 3.24), number of hospitalisations (odds ratio (OR) 0.26, 95% CI 0.02 to 2.79) or lung function (forced expiratory volume in one second (FEV1) and forced vital capacity (FVC)). Investigators reported 37 adverse events in the ICS group versus 12 events in the ICS-LABA group butdid not mention the number of individuals experiencing adverse events. Hence differences between groups were not included in the analyses. We assessed the overall evidence to be low quality.Authors' conclusions: In adults with bronchiectasis without co-existent asthma, during stable state, a small single trial with a high risk of bias suggests that combined ICS-LABA may improve dyspnoea and increase cough-free days in comparison with high-dose ICS. No data are provided for or against, the use of combined ICS-LABA in adults with bronchiectasis during an acute exacerbation, or in children with bronchiectasis in a stable or acute state. The absence of high quality evidence means that decisions to use or discontinue combined ICS-LABA in people with bronchiectasis may need to take account of the presence or absence of co-existing airway hyper-responsiveness and consideration of adverse events associated with combinedICS-LABA.

U2 - 10.1002/14651858.CD010327.pub2

DO - 10.1002/14651858.CD010327.pub2

M3 - Article

VL - 2014

SP - 1

EP - 24

JO - Cochrane database of systematic reviews (Online)

JF - Cochrane database of systematic reviews (Online)

SN - 1469-493X

IS - 6

M1 - CD010327

ER -