Dose response of inhaled corticosteroids on bronchial hyperresponsiveness: a meta-analysis.

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Abstract

BACKGROUND: There is a relatively steep dose-response curve for effects of inhaled corticosteroids on conventional airway markers of asthmatic disease control. OBJECTIVE: We sought to determine whether a dose-response effect exists for bronchial hyperresponsiveness. METHODS: A meta-analysis of placebo-controlled trials in asthmatic patients was performed using a computerized systematic review of databases. Doubling dose/dilution protection of inhaled corticosteroid was compared with placebo. Studies which used direct (methacholine and histamine) and indirect (adenosine monophosphate) bronchial challenge stimuli were eligible for inclusion. RESULTS: Twenty-five studies fulfilled eligibility criteria (963 patients). Values for doubling dose/dilution protection categorized by low/medium dose (< 1,000 microg) and high dose (> or = 1,000 microg) of inhaled corticosteroid amounted to a 1.25 (95% confidence interval 1.08 to 1.42) and 2.16 (95% confidence interval 1.88 to 2.44) shift, respectively. CONCLUSIONS: High doses of inhaled corticosteroids conferred greater improvements in bronchial hyperresponsiveness than low doses.

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Administration, Inhalation; Bronchial Provocation Tests; Dose-Response Relationship, Drug; Humans; Research Support, Non-U.S. Gov't; Steroids; Treatment Outcome; administration & dosage: Anti-Asthmatic Agents; administration & dosage: Anti-Inflammatory Agents; diagnostic use: Bronchoconstrictor Agents; drug therapy: Asthma; drug therapy: Bronchial Hyperreactivity; methods: Randomized Controlled Trials

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