The Cochrane Library and Long-Acting Beta-agonist Treatment for Childhood Asthma: An Overview of Reviews

Background Asthma is characterized by chronic airway inflammation and affects many children. One treatment option used to control asthma symptoms is the class of medications known as the long acting β2‐agonists (LABA) and they are often used in combination with inhaled corticosteroids (ICS). The use of LABA in children has been widely debated in the literature. Objectives To synthesize the evidence currently in the Cochrane Library of systematic reviews related to the question: ‘In children with symptomatic asthma, does treatment with a LABA as a primary or add‐on therapy to ICS improve objective measures of lung function and asthma symptom control, reduce exacerbations, and improve quality of life?’. Methods The Cochrane Database of Systematic Reviews was searched using the term ‘asthma’ in the title for all systematic reviews examining LABA vs any other pharmacological agent for the treatment of asthma. Data were extracted and entered into tables; syntheses occurred using qualitative and quantitative methods. Main Results Seven reviews were identified; however, only four reviews contained data for children. There was no significant difference in the asthma exacerbations among those treated with LABA or any other treatment. For those treated with LABA with no/varied ICS vs placebo with no/varied ICS, there was a significant improvement in percent predicted forced expiratory volume in the first second (FEV1) and a significant number of children had a ≥ 15% increase in FEV1. There was also a significant reduction in the change in whole day rescue medication, fewer asthma related night‐time wakenings, and lower symptom scores for LABA with no/varied ICS. Change in FEV1 (Litres (L) or percent predicted) and improvement in morning and evening peak expiratory flow (PEF) favoured LABA and ICS vs fixed dose ICS and placebo. There was a significantly higher risk of adverse events among those receiving LABA and ICS compared to ICS with or without placebo. Authors' Conclusions There is no clear benefit to LABA in preventing asthma exacerbations in children. While there is a paucity of evidence in this area, ICS should remain the controller therapy of choice; however, the addition of LABA to ICS may result in improvement in pulmonary function measures, reduce the use of rescue medications and improve quality of life measures in children with chronic asthma. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration