Inhaled corticosteroids for cystic fibrosis

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Title: Inhaled corticosteroids for cystic fibrosis
Authors: Balfour-Lynn, IM
Welch, K
Item Type: Journal Article
Abstract: Background Reduction of lung inflammation is one of the goals of cystic fibrosis therapy. Inhaled corticosteroids are often used to treat children and adults with cystic fibrosis. The rationale for this is their potential to reduce lung damage arising from inflammation, as well as their effect on symptomatic wheezing. It is important to establish the current level of evidence for the risks and benefits of inhaled corticosteroids, especially in the light of their known adverse effects on growth. This is an update of a previously published review. Objectives To assess the effectiveness of taking regular inhaled corticosteroids, compared to not taking them, in children and adults with cystic fibrosis. Search methods We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register, comprising references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. We requested information from pharmaceutical companies manufacturing inhaled corticosteroids and authors of identified trials. Date of most recent search of the Group's Trials Register: 15 August 2016. Selection criteria Randomised or quasi-randomised trials, published and unpublished, comparing inhaled corticosteroids to placebo or standard treatment in individuals with cystic fibrosis. Data collection and analysis Two independent authors assessed methodological quality and risk of bias in trials using established criteria and extracted data using standard pro formas. Main results The searches identified 34 citations, of which 26 (representing 13 trials) were eligible for inclusion. These 13 trials reported the use of inhaled corticosteroids in 506 people with cystic fibrosis aged between six and 55 years. One was a withdrawal trial in individuals who were already taking inhaled corticosteroids. Methodological quality and risk of bias were difficult to assess from published information. Many of the risk of bias judgements were unclear due to a lack of available information. Only two trials specified how participants were randomised and less than half of the included trials gave details on how allocation was concealed. Trials were generally judged to have a low risk of bias from blinding, except for two which were open label or did not use a placebo. There were some concerns that a number of trials had not been published in peer-reviewed journals, but the risk of bias from this was unclear. Inclusion criteria varied between trials, as did type and duration of treatment and timing of outcome assessments. Objective measures of airway function were reported in most trials but were often incomplete. Significant benefit has not been conclusively demonstrated. Four trials systematically documented adverse effects and growth was significantly affected in one study using high doses. Authors' conclusions Evidence from these trials is insufficient to establish whether inhaled corticosteroids are beneficial in cystic fibrosis, but withdrawal in those already taking them has been shown to be safe. There is some evidence they may cause harm in terms of growth. It has not been established whether long-term use is beneficial in reducing lung inflammation, which should improve survival, but it is unlikely this will be proven conclusively in a randomised controlled trial.
Issue Date: 23-Aug-2016
Date of Acceptance: 23-Aug-2016
URI: http://hdl.handle.net/10044/1/56066
DOI: https://dx.doi.org/10.1002/14651858.CD001915.pub5
ISSN: 1469-493X
Publisher: Cochrane Collaboration
Journal / Book Title: Cochrane Database of Systematic Reviews
Volume: 2016
Issue: 8
Copyright Statement: Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
Administration, Inhalation
Anti-Inflammatory Agents [administration & dosage; adverse effects]
Cystic Fibrosis [drug therapy]
Glucocorticoids [administration & dosage; adverse effects]
Randomized Controlled Trials as Topic
Adolescent
Adult
Child
Humans
Middle Aged
Young Adult
SYMPTOMATIC ADRENAL INSUFFICIENCY
FLUTICASONE PROPIONATE
AIRWAY INFLAMMATION
LUNG-FUNCTION
BRONCHIAL HYPERRESPONSIVENESS
SUPPRESSION SECONDARY
ASTHMATIC-CHILDREN
CONTROLLED-TRIAL
DISEASE
BUDESONIDE
Administration, Inhalation
Adolescent
Adult
Anti-Inflammatory Agents
Budesonide
Child
Cystic Fibrosis
Fluticasone
Glucocorticoids
Humans
Middle Aged
Randomized Controlled Trials as Topic
Young Adult
Humans
Cystic Fibrosis
Budesonide
Anti-Inflammatory Agents
Glucocorticoids
Administration, Inhalation
Adolescent
Adult
Middle Aged
Child
Randomized Controlled Trials as Topic
Young Adult
Fluticasone
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
Administration, Inhalation
Anti-Inflammatory Agents [administration & dosage; adverse effects]
Cystic Fibrosis [drug therapy]
Glucocorticoids [administration & dosage; adverse effects]
Randomized Controlled Trials as Topic
Adolescent
Adult
Child
Humans
Middle Aged
Young Adult
SYMPTOMATIC ADRENAL INSUFFICIENCY
FLUTICASONE PROPIONATE
AIRWAY INFLAMMATION
LUNG-FUNCTION
BRONCHIAL HYPERRESPONSIVENESS
SUPPRESSION SECONDARY
ASTHMATIC-CHILDREN
CONTROLLED-TRIAL
DISEASE
BUDESONIDE
11 Medical And Health Sciences
General & Internal Medicine
Publication Status: Published
Article Number: CD001915
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine



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