Published on October 18, 2005 at 8:59 PM
Ni Croinin and colleagues reviewed 26 studies that included 8,147 patients. Greenstone and colleagues analyzed 30 studies that included 9,509 patients. Only eight of the studies in the Ni Croinin review and three studies in the Greenstone review focused on children with asthma.
"I think the lack of data for pediatrics is certainly a problem which may limit the use of LABA in that age group. There just aren't enough studies to make evidence-based clinical decisions," Greenstone says.
The Cochrane reviewers say their work may help physicians decide when or if to prescribe LABA medications to asthma patients already taking inhaled steroids.
"My sense is that there is a tendency to initiate combination therapy with inhaled corticosteroids and LABAs," rather than start with steroids and add LABA drugs later on in patients with uncontrolled asthma, says Jerry Krishnan, M.D., an asthma researcher and assistant professor of medicine and epidemiology at the Johns Hopkins University School of Medicine. "This practice is likely to be driven in part by the step-down approach, where more aggressive therapy is initiated, then stepped down once control is achieved."
Almost all the studies reviewed by both Ni Croinin and Greenstone and colleagues were sponsored by the manufacturers of either LABA medications or inhaled steroids. Francine Ducharme, M.D., an author on both reviews, has received speaking and consulting fees from AstraZeneca (producer of formoterol and the steroid budesonide), GlaxoSmithKline (producer of the steroids fluticasone and beclomethasone and salmeterol), and Novartis (producer of formoterol).