Abstract
Background: Previous studies suggest that inhaled budesonide-formoterol used as needed could effectively reduce the severe exacerbation of mild persistent asthma. However, there are some differences between these studies, so we conducted a meta-analysis. Methods: We searched PubMed, Ovid MEDLINE, Cochrane Library and several web search engines to screen the literature until March 25, 2020 and used risk ratios (RR), odds ratios, hazard ratios (HR) and weighted mean differences with 95% confidence intervals (CI) to evaluate the pooled effects. Adolescent/adult patients with mild persistent asthma who used budesonide–formoterol as needed were included in this study. The primary outcome was to investigate the superiority of budesonide–formoterol as needed in reducing severe exacerbations in patients with mild persistent asthma. STATA 12.0 software was used for statistical analysis. Results: Across all 4 articles, 4,023 patients used budesonide–formoterol as needed (budesonide–formoterol group), 4,042 patients used budesonide maintenance plus short-acting β2-agonist (SABA) as needed (budesonide group), and 1,500 patients used SABA as needed (SABA group). The results showed that the incidence of severe exacerbations and the time to first severe exacerbation in the budesonide–formoterol group were significantly different from those for the SABA group (RR = 0.46, 95% CI = 0.36–0.59, p < 0.001; HR = 0.43, 95% CI = 0.33–0.56, p < 0.001; respectively), but there was no difference between the budesonide–formoterol group and budesonide group (RR = 0.86, 95% CI = 0.62–1.04, p = 0.093; HR = 0.77, 95% CI = 0.57–1.03, p = 0.079; respectively). There were statistically significant differences in the forced expiratory volume in 1 second and in the responses to the Asthma Control Questionnaire-5 between the budesonide-formoterol group and the SABA group, but the differences were not clinically significant. In addition, the daily dose of budesonide in the budesonide–formoterol group was significantly lower than that in the budesonide group, and there was no difference in the incidence of adverse events among the three groups. Conclusion: In summary, budesonide–formoterol used as needed may reduce severe exacerbation in adolescent/adult patients with mild persistent asthma.
Highlights
Asthma is a heterogeneous lung disease and an important global public health problem affecting all age groups that is usually characterized by chronic airway inflammation (Global Initiative for Asthmam, 2019)
The results showed that the incidence of severe exacerbations and the time to first severe exacerbation in the budesonide–formoterol group were significantly different from those for the SABA group (RR 0.46, 95% confidence intervals (CI) 0.36–0.59, p < 0.001; hazard ratios (HR) 0.43, 95% CI 0.33–0.56, p < 0.001; respectively), but there was no difference between the budesonide–formoterol group and budesonide group (RR 0.86, 95% CI 0.62–1.04, p 0.093; HR 0.77, 95% CI 0.57–1.03, p 0.079; respectively)
The results showed that there was a significant difference between the budesonide–formoterol group and the SABA group (RR 0.46, 95% CI 0.36–0.59, p < 0.001), but there was no significant difference between the budesonide–formoterol group and the budesonide group (RR 0.86, 95% CI 0.62–1.04, p 0.093) (Figure 2)
Summary
Asthma is a heterogeneous lung disease and an important global public health problem affecting all age groups that is usually characterized by chronic airway inflammation (Global Initiative for Asthmam, 2019). It should be noted that they still present with airway inflammation and have an increased risk of exacerbation and asthma-related death due to inadequate use of inhaled glucocorticoids (Fuhlbrigge et al, 2002; Barnes and Ulrik, 2015). A study from the United States found that 3.6% of patients with mild asthma were hospitalized due to deterioration of their condition; 16.1% of patients with intermittent asthma and 28.4% of patients with mild asthma needed emergency treatment in the previous year (Fuhlbrigge et al, 2002). Previous studies have shown that the use of SABA may increase the risk of exacerbation, disease progression and death in patients with asthma (Suissa et al, 1994; Stanford et al, 2012). Previous studies suggest that inhaled budesonide-formoterol used as needed could effectively reduce the severe exacerbation of mild persistent asthma. There are some differences between these studies, so we conducted a meta-analysis
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