Inhaled corticosteroids compared to placebo for prevention of exercise induced bronchoconstriction

Koh MS, Tee A, Lasserson TJ, Irving LB

Published Online:

April 15, 2009

Exercise-induced asthma (bronchoconstriction) can limit a person's exercise endurance and lead to people avoiding exercise. This systematic review found that inhaled corticosteroids taken regularly can reduce exercise induced asthma in both children and adults.

Abstract (click to read)

Background:

The pathogenesis of exercise induced bronchoconstriction is likely multifactorial and is not completely understood. Inflammation plays an important role in the pathogenesis of exercise induced bronchoconstriction in asthmatic subjects but the evidence seems less strong in non-asthmatic subjects. The management of exercise induced bronchoconstriction focuses on prevention, through both pharmacologic and non-pharmacologic interventions.

Objectives:

The objectives of this review were to evaluate the use of inhaled corticosteroids in the treatment of exercise induced bronchoconstriction in a systematic way. Specifically, the review was designed to:

determine whether inhaled corticosteroids (compared to placebo) has an attenuating effect on exercise induced bronchoconstriction in adult and pediatric asthmatic patients;
estimate the magnitude of the attenuating effect.

Search strategy:

We searched the Cochrane Airways Review Group Specialised Register of trials, the Cochrane Central Register of Controlled Trials, review articles, textbooks and reference list of articles.

Selection criteria:

Randomised trials in adults or children comparing inhaled corticosteroids with placebo to prevent bronchoconstriction in patients with exercise induced bronchoconstriction.

Data collection and analysis:

Trial quality assessment and data extraction were conducted independently by two reviewers.

Main results:

The results from eight randomised controlled trials involving 162 participants were analyzed (two trials involving adults and six involving children). Combining results from the three parallel studies with at least 4 weeks duration of inhaled corticosteroids, the use of inhaled corticosteroids significantly attenuated the percent fall index in forced expiratory volume in 1 second (WMD (fixed): 11.74%; 95% CI: 10.06% to 13.42%). The result from one crossover study with duration of inhaled corticosteroids of 4 weeks revealed significant attenuation of percent fall in forced expiratory volume in 1 second ( WMD 11.70%; 95% CI: 7.51% to 15.90%) and the percent fall in peak expiratory flow ( WMD 11.50%; 95% CI: 6.31% to 16.69%). The small amount of data from placebo-controlled trials using a single treatment do not currently allow conclusions to be drawn.

Authors' conclusions:

Inhaled corticosteroids used for 4 weeks or more before exercise testing significantly attenuated exercise-induced bronchoconstriction. The relative benefits of inhaled corticosteroids compared to other forms of exercise induced bronchoconstriction treatment (sodium cromoglycate, nedocromil sodium, salbutamol, and other anti-inflammatory agents) remains unclear.

This record should be cited as:

Koh MS, Tee A, Lasserson TJ, Irving LB. Inhaled corticosteroids compared to placebo for prevention of exercise induced bronchoconstriction. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD002739. DOI: 10.1002/14651858.CD002739.pub3

Assessed as up to date:

October 29, 2008

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Primary Review Group:

Airways Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

Are inhaled corticosteroids effective in exercise-induced asthma?

Bottom line:

Compared to placebo, inhaled corticosteroids used regularly for 4 weeks or more before exercise testing significantly attenuated exercise-induced bronchoconstriction in both children and adults.

Caveat:

The relative benefits of inhaled corticosteroids compared to other forms of exercise-induced bronchoconstriction treatment (sodium cromoglycate, nedocromil sodium, salbutamol, and other anti-inflammatory agents) remain unclear. Review involved only 6 studies with numbers of participants ranging from 9 to 40.

Context:

Exercise induced asthma can limit a person’s exercise endurance and lead to people avoiding exercise. Depending on study population, exercise protocol, detection method and exercise conditions, prevalence of exercise-induced asthma ranges from 10 to 50%.

Cochrane Systematic Review:

Koh MS et al. Inhaled corticosteroids compared to placebo for prevention of exercise -induced bronchoconstriction. Cochrane Reviews 2007, Issue 3. Art No: CD002739.DOI: 10.1002/14651858. CD002739.pub 3. The review contains 6 studies involving 123 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Lungs & airways > Exercise-induced bronchoconstriction

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Inhaled corticosteroids compared to placebo for prevention of exercise induced bronchoconstriction

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