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Systematic review and meta-analysis
Inconclusive evidence about the efficacy of diverse strategies for intermittent versus daily inhaled corticosteroids for persistent asthma in adults and children
  1. Helen K Reddel,
  2. Juliet M Foster
  1. Woolcock Institute of Medical Research, University of Sydney, Glebe, New South Wales, Australia
  1. Correspondence to Associate Professor Helen K Reddel
    Clinical Management Group, Woolcock Institute of Medical Research, 431 Glebe Point Road, Glebe, NSW 2037, Australia; helen.reddel{at}

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Although inhaled corticosteroids (ICS) are remarkably effective for improving asthma control and reducing mortality, many patients avoid regular use, often stopping treatment when symptoms improve.1 There is increasing interest in investigating ICS regimens which do not require daily treatment.


The aim of this review was to evaluate parallel group trials comparing daily ICS with ‘intermittent’ ICS in persistent asthma, with ‘intermittent’ defined as ICS initiated ‘at the onset of exacerbations and continued for a short duration’. Studies were identified from the Cochrane Airways Group specialised register of trials, together with hand-searching. The search terms included: intermittent, as-needed, prn (prescribed-as-needed), occasional and short course; these emerged as having highly variable meanings. Eligible patients were adults and children with persistent asthma (undefined) and preschool children at risk of, or with suspected, asthma. Combination ICS/short-acting β2-agonist (SABA) was permitted but not ICS/long-acting …

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  • Competing interests HKR has participated in advisory boards for AstraZeneca and Novartis, received consultancy fees from GlaxoSmithKline, lecture fees from AstraZeneca, Getz Pharma and MSD, research grants from AstraZeneca and GlaxoSmithKline, and is participating in a data monitoring committee for AstraZeneca, GlaxoSmithKline, Merck and Novartis. JMF has received a research grant from GlaxoSmithKline and AstraZeneca and lecture fees from GlaxoSmithKline and AstraZeneca.