Effects of guide-recommended treatment strategies on asthma symptom scores in moderate-to-severe asthma patients aged 5-18 years: a network meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

LI Jianrong ¹ , LIU Fengqi ¹ , LIU Zuoxiang ¹ , PENG Hexiang ¹ , ZENG Xueyang ¹ , CHEN Yahong ² ,  WU Tao ^1,3 ,  SUN Feng ^1,3,4

1. Department of Epidemiology and Health Statistics, School of Public Health, Peking University, Beijing 100191, P. R. China;
2. Department of Respiratory Medicine, Peking University Third Hospital, Beijing 100191, P. R. China;
3. Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, P. R. China;
4. Peking University Center for Evidence Based Medicine and Clinical Research, Beijing 100191, P. R. China;

Corresponding?author：

WU Tao, Email: twu@bjmu.edu.cn; SUN Feng, Email: sunfeng@bjmu.edu.cn

Keywords：

Asthma; Children and adolescents; Asthma symptom score; Network meta-analysis

DOI：

10.7507/1672-2531.202309050

Video：

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Objectives To evaluate the improvement of symptoms in patients with moderate to severe asthma aged 5-18 years treated with GINA (Global Initiative for Asthma) guidelines by network meta-analysis. Methods Randomized controlled trials (RCTs) about asthma patients aged 5 to 18 years with reported asthma symptom scores were collected from PubMed, Embase, Cochrane Library, CNKI, WanFang Data, VIP, SinoMed and clinical trial registry platform (ClinicalTrials.gov). The search time limit was from the inception to August 26, 2023. After two researchers independently screened literature, extracted data and evaluated the risk of bias of included studies, Stata 15.0 software was used for network meta-analysis. Results A total of 23 studies were included, 23 of which reported daytime asthma symptom scores. Compared with symptom scores in the low-dose ICS group, there was a statistically significant difference in improvement of daytime symptoms between low-dose ICS+LABA+LTRA (SMD=?1.4, 95%CI ?1.99 to ?0.81) and low-dose ICS+LABA+SABA (SMD=?1.43, 95%CI ?2.48 to ?0.39). Symptom scores for nighttime asthma were reported in 20 RCTs, and there was a statistically significant difference in symptom scores for low-dose ICS+LABA+LTRA (SMD=?1.20, 95%CI ?2.20 to ?0.21) compared with the low-dose ICS group. After the ranking of efficacy, the number one asthma symptom score in both daytime and nighttime was low-dose ICS+LABA+LTRA group. Conclusion Low dose ICS+LABA+LTRA has the best efficacy in improving daytime and nighttime asthma symptom scores.

Citation： LI Jianrong, LIU Fengqi, LIU Zuoxiang, PENG Hexiang, ZENG Xueyang, CHEN Yahong, WU Tao, SUN Feng. Effects of guide-recommended treatment strategies on asthma symptom scores in moderate-to-severe asthma patients aged 5-18 years: a network meta-analysis. Chinese Journal of Evidence-Based Medicine, 2024, 24(9): 1044-1051. doi: 10.7507/1672-2531.202309050 Copy

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2.	Papi A, Brightling C, Pedersen SE, et al. Asthma. Lancet, 2018, 391(10122): 783-800.
3.	中華兒科雜志編輯委員會, 中華醫學會兒科學分會呼吸學組, 中國醫師協會兒科醫師分會兒童呼吸專業委員會. 兒童支氣管哮喘規范化診治建議(2020年版). 中華兒科雜志, 2020, 58(9): 708-717.
4.	Busse WW, Chervinsky P, Condemi J, et al. Budesonide delivered by turbuhaler is effective in a dose-dependent fashion when used in the treatment of adult patients with chronic asthma. J Allergy Clin Immunol, 1998, 101(4 Pt 1): 457-463.
5.	Bateman ED, Hurd SS, Barnes PJ, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J, 2008, 31(1): 143-178.
6.	Global Initiative for Asthma. Global strategy for asthma management and prevention. 2021.
7.	Ahmed H, Turner S. Severe asthma in children-a review of definitions, epidemiology, and treatment options in 2019. Pediatr Pulmonol, 2019, 54(6): 778-787.
8.	Guilbert TW, Bacharier LB, Fitzpatrick AM. Severe asthma in children. J Allergy Clin Immunol Pract, 2014, 2(5): 489-500.
9.	Sterne JAC, Savovi? J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 2019, 28(366): 1756-1833.
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11.	Veroniki AA, Vasiliadis HS, Higgins JP, et al. Evaluation of inconsistency in networks of interventions. Int J Epidemiol, 2013, 42(1): 332-345.
12.	Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol, 2011, 64(2): 163-171.
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18.	付睿, 趙艷飛, 楊慧湘, 等. 沙美特羅替卡松氣霧劑治療重度支氣管哮喘患兒的療效及對肺功能、炎性因子的影響. 中國婦幼保健, 2018, 33(21): 4930-4933.
19.	黃勝奇, 農定猛, 吳昔林, 等. 布地奈德聯合沙美特羅對兒童中重度哮喘的治療分析. 中外醫療, 2013, 32(10): 1-2.
20.	黃肖梅, 黃衛娟, 陳建江, 等. 沙美特羅替卡松單用與丙酸氟替卡松聯合孟魯司特鈉治療兒童中度持續哮喘的療效比較. 中國藥房, 2016, 27(23): 3240-3243.
21.	黃鶯. 丙酸氟替卡松聯合孟魯司特鈉對中度持續哮喘患兒的肺功能及炎癥因子的影響. 慢性病學雜志, 2019, 20(3): 384-386.
22.	黃志剛. 丙酸氟替卡松和沙美特羅聯合治療小兒中、重度哮喘的臨床效果分析. 臨床醫藥文獻電子雜志, 2014, 1(5): 773-774.
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26.	譚仕凱. 信必可都保聯合孟魯司特治療中度、重度哮喘患兒的療效觀察. 吉林醫學, 2013, 34(25): 5116-5117.
27.	王素梅, 王大斌. 沙美特羅替卡松與孟魯司特鈉聯合治療中重度支氣管哮喘的療效. 實用兒科臨床雜志, 2010, 25(16): 1249-1250.
28.	鄔菊花, 徐佩茹, 多力坤, 等. 舒利迭治療兒童哮喘呼氣峰流速及癥狀評分情況的觀察. 新疆醫學, 2005, 3: 72-74.
29.	武怡, 路明. 沙美特羅/丙酸氟替卡松干粉與布地奈德干粉吸入治療兒童哮喘的臨床觀察. 徐州醫學院學報, 2007, 5: 339-341.
30.	謝勇軍. 孟魯司特聯合吸入糖皮質激素治療小兒慢性中度持續支氣管哮喘的臨床療效. 臨床合理用藥雜志, 2016, 9(12): 15-17.
31.	應紅霞. 白三烯受體拮抗劑孟魯司特鈉治療兒童中重度哮喘的療效觀察. 中國全科醫學, 2009, 12(3): 245-246.
32.	陳碧香, 李陳. 吸入糖皮質激素聯合小劑量茶堿白三烯調節劑治療5歲以下兒童哮喘的臨床研究. 基層醫學論壇, 2017, 21(29): 3957-3958.
33.	李志輝, 辛淑君, 王影齊, 等. 孟魯司特聯合吸入糖皮質激素治療小兒中度持續哮喘的療效及機制. 中國實用醫藥, 2008, 3(16): 38-40.
34.	王廣俊, 吳慶莉, 林榮軍. 布地奈德福莫特羅粉吸入劑與布地奈德粉吸入劑聯合富馬酸福莫特羅粉吸入劑治療哮喘的療效及安全性. 實用兒科臨床雜志, 2011, 26(4): 3.
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37.	Murray CS, Custovic A, Lowe LA, et al. Effect of addition of salmeterol versus doubling the dose of fluticasone propionate on specific airway resistance in children with asthma. Allergy Asthma Proc, 2010, 31(5): 415-421.
38.	P?oszczuk A, Bosheva M, Spooner K, et al. Efficacy and safety of fluticasone propionate/formoterol fumarate in pediatric asthma patients: a randomized controlled trial. Therapeutic Advances in Respiratory Disease, 2018: 12.
39.	Sheikh SI, Ryan-Wenger NA, Pitts J, et al. Impact of asthma severity on long-term asthma control. J Asthma, 2021, 58(6): 725-734.
40.	鄒曉東, 王偉, 黃紹光. 哮喘癥狀評分臨床應用價值. 現代診斷與治療, 1993, (3): 284-286.
41.	Gater A, Nelsen L, Coon CD, et al. Asthma daytime symptom diary (ADSD) and asthma nighttime symptom diary (ANSD): measurement properties of novel patient-reported symptom measures. J Allergy Clin Immunol Pract, 2022, 10(5): 1249-1259.
42.	Zhao Y, Han S, Shang J, et al. Effectiveness of drug treatment strategies to prevent asthma exacerbations and increase symptom-free days in asthmatic children: a network meta-analysis. J Asthma, 2015, 52(8): 846-857.
43.	Sobieraj DM, Baker WL, Nguyen E, et al. Association of inhaled corticosteroids and long-acting muscarinic antagonists with asthma control in patients with uncontrolled, persistent asthma: a systematic review and meta-analysis. JAMA, 2018, 319(14): 1473-1484.
44.	Kim LHY, Saleh C, Whalen-Browne A, et al. Triple vs dual inhaler therapy and asthma outcomes in moderate to severe asthma: a systematic review and meta-analysis. JAMA, 2021, 325(24): 2466-2479.
45.	Agusti A, Fabbri L, Lahousse L, et al. Single inhaler triple therapy (SITT) in asthma: systematic review and practice implications. Allergy, 2022, 77(4): 1105-1113.
46.	Kaplan A, FitzGerald JM, Buhl R, et al. Comparing LAMA with LABA and LTRA as add-on therapies in primary care asthma management. NPJ Prim Care Respir Med, 2020, 30(1): 50.
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1. 吳嘉嬰, 洪建國. 兒童支氣管哮喘診斷和防治指南(2016年版)更新要點. 世界臨床藥物, 2018, 39(8): 512-517.
2. Papi A, Brightling C, Pedersen SE, et al. Asthma. Lancet, 2018, 391(10122): 783-800.
3. 中華兒科雜志編輯委員會, 中華醫學會兒科學分會呼吸學組, 中國醫師協會兒科醫師分會兒童呼吸專業委員會. 兒童支氣管哮喘規范化診治建議(2020年版). 中華兒科雜志, 2020, 58(9): 708-717.
4. Busse WW, Chervinsky P, Condemi J, et al. Budesonide delivered by turbuhaler is effective in a dose-dependent fashion when used in the treatment of adult patients with chronic asthma. J Allergy Clin Immunol, 1998, 101(4 Pt 1): 457-463.
5. Bateman ED, Hurd SS, Barnes PJ, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J, 2008, 31(1): 143-178.
6. Global Initiative for Asthma. Global strategy for asthma management and prevention. 2021.
7. Ahmed H, Turner S. Severe asthma in children-a review of definitions, epidemiology, and treatment options in 2019. Pediatr Pulmonol, 2019, 54(6): 778-787.
8. Guilbert TW, Bacharier LB, Fitzpatrick AM. Severe asthma in children. J Allergy Clin Immunol Pract, 2014, 2(5): 489-500.
9. Sterne JAC, Savovi? J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 2019, 28(366): 1756-1833.
10. Chaimani A, Mavridis D, Salanti G. A hands-on practical tutorial on performing meta-analysis with Stata. Evid Based Ment Health, 2014, 17(4): 111-116.
11. Veroniki AA, Vasiliadis HS, Higgins JP, et al. Evaluation of inconsistency in networks of interventions. Int J Epidemiol, 2013, 42(1): 332-345.
12. Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol, 2011, 64(2): 163-171.
13. Chaimani A, Higgins JP, Mavridis D, et al. Graphical tools for network meta-analysis in STATA. PLoS One, 2013, 8(10): e76654.
14. Puhan MA, Schünemann HJ, Murad MH, et al. A GRADE working group approach for rating the quality of treatment effect estimates from network meta-analysis. BMJ, 2014, 349: g5630.
15. 王琪, 王韻華, 賴鴻皓, 等. 網狀Meta分析證據質量分級: CINeMA在線應用程序簡介. 中國循證醫學雜志, 2020, 20(9): 1111-1116.
16. 蔡勇輝, 盧浩堂, 馮科壬, 等. 吸入糖皮質激素聯合小劑量茶堿與聯合白三烯調節劑治療5歲以下兒童哮喘的效果比較. 中國當代醫藥, 2014, 21(2): 103-106.
17. 陳慶海. 小劑量糖皮質激素聯合口服茶堿片治療小兒哮喘的療效觀察. 中國中西醫結合兒科學, 2016, 8(3): 286-289.
18. 付睿, 趙艷飛, 楊慧湘, 等. 沙美特羅替卡松氣霧劑治療重度支氣管哮喘患兒的療效及對肺功能、炎性因子的影響. 中國婦幼保健, 2018, 33(21): 4930-4933.
19. 黃勝奇, 農定猛, 吳昔林, 等. 布地奈德聯合沙美特羅對兒童中重度哮喘的治療分析. 中外醫療, 2013, 32(10): 1-2.
20. 黃肖梅, 黃衛娟, 陳建江, 等. 沙美特羅替卡松單用與丙酸氟替卡松聯合孟魯司特鈉治療兒童中度持續哮喘的療效比較. 中國藥房, 2016, 27(23): 3240-3243.
21. 黃鶯. 丙酸氟替卡松聯合孟魯司特鈉對中度持續哮喘患兒的肺功能及炎癥因子的影響. 慢性病學雜志, 2019, 20(3): 384-386.
22. 黃志剛. 丙酸氟替卡松和沙美特羅聯合治療小兒中、重度哮喘的臨床效果分析. 臨床醫藥文獻電子雜志, 2014, 1(5): 773-774.
23. 廖翠芳. 沙美特羅替卡松聯合孟魯司特治療兒童中度哮喘分析. 現代醫院, 2007, 3: 27-29.
24. 呂燕芬. 孟魯司特聯合布地奈德治療兒童中度哮喘療效觀察. 海峽藥學, 2006, 6: 105.
25. 梅忠卓. 布地奈德聯合沙美特羅治療兒童中重度哮喘的臨床療效. 醫學臨床研究, 2012, 29(12): 2328-2329.
26. 譚仕凱. 信必可都保聯合孟魯司特治療中度、重度哮喘患兒的療效觀察. 吉林醫學, 2013, 34(25): 5116-5117.
27. 王素梅, 王大斌. 沙美特羅替卡松與孟魯司特鈉聯合治療中重度支氣管哮喘的療效. 實用兒科臨床雜志, 2010, 25(16): 1249-1250.
28. 鄔菊花, 徐佩茹, 多力坤, 等. 舒利迭治療兒童哮喘呼氣峰流速及癥狀評分情況的觀察. 新疆醫學, 2005, 3: 72-74.
29. 武怡, 路明. 沙美特羅/丙酸氟替卡松干粉與布地奈德干粉吸入治療兒童哮喘的臨床觀察. 徐州醫學院學報, 2007, 5: 339-341.
30. 謝勇軍. 孟魯司特聯合吸入糖皮質激素治療小兒慢性中度持續支氣管哮喘的臨床療效. 臨床合理用藥雜志, 2016, 9(12): 15-17.
31. 應紅霞. 白三烯受體拮抗劑孟魯司特鈉治療兒童中重度哮喘的療效觀察. 中國全科醫學, 2009, 12(3): 245-246.
32. 陳碧香, 李陳. 吸入糖皮質激素聯合小劑量茶堿白三烯調節劑治療5歲以下兒童哮喘的臨床研究. 基層醫學論壇, 2017, 21(29): 3957-3958.
33. 李志輝, 辛淑君, 王影齊, 等. 孟魯司特聯合吸入糖皮質激素治療小兒中度持續哮喘的療效及機制. 中國實用醫藥, 2008, 3(16): 38-40.
34. 王廣俊, 吳慶莉, 林榮軍. 布地奈德福莫特羅粉吸入劑與布地奈德粉吸入劑聯合富馬酸福莫特羅粉吸入劑治療哮喘的療效及安全性. 實用兒科臨床雜志, 2011, 26(4): 3.
35. Nawaz S, Ahmed RI, Arzoo K, et al. Comparison of montelukast and ketotifen sodium in management of childhood asthma. Rawal Medical Journal, 2021, 46(3): 500-502.
36. Olszowiec-Chlebna M, Majak P, Brzozowska A, et al. Effect of inhaled steroid and montelukast on clinical symptoms in children with newly diagnosed asthma: a pilot study. Pediatric allergy immuno, 2010, 21(4 Pt 2): e687-e690.
37. Murray CS, Custovic A, Lowe LA, et al. Effect of addition of salmeterol versus doubling the dose of fluticasone propionate on specific airway resistance in children with asthma. Allergy Asthma Proc, 2010, 31(5): 415-421.
38. P?oszczuk A, Bosheva M, Spooner K, et al. Efficacy and safety of fluticasone propionate/formoterol fumarate in pediatric asthma patients: a randomized controlled trial. Therapeutic Advances in Respiratory Disease, 2018: 12.
39. Sheikh SI, Ryan-Wenger NA, Pitts J, et al. Impact of asthma severity on long-term asthma control. J Asthma, 2021, 58(6): 725-734.
40. 鄒曉東, 王偉, 黃紹光. 哮喘癥狀評分臨床應用價值. 現代診斷與治療, 1993, (3): 284-286.
41. Gater A, Nelsen L, Coon CD, et al. Asthma daytime symptom diary (ADSD) and asthma nighttime symptom diary (ANSD): measurement properties of novel patient-reported symptom measures. J Allergy Clin Immunol Pract, 2022, 10(5): 1249-1259.
42. Zhao Y, Han S, Shang J, et al. Effectiveness of drug treatment strategies to prevent asthma exacerbations and increase symptom-free days in asthmatic children: a network meta-analysis. J Asthma, 2015, 52(8): 846-857.
43. Sobieraj DM, Baker WL, Nguyen E, et al. Association of inhaled corticosteroids and long-acting muscarinic antagonists with asthma control in patients with uncontrolled, persistent asthma: a systematic review and meta-analysis. JAMA, 2018, 319(14): 1473-1484.
44. Kim LHY, Saleh C, Whalen-Browne A, et al. Triple vs dual inhaler therapy and asthma outcomes in moderate to severe asthma: a systematic review and meta-analysis. JAMA, 2021, 325(24): 2466-2479.
45. Agusti A, Fabbri L, Lahousse L, et al. Single inhaler triple therapy (SITT) in asthma: systematic review and practice implications. Allergy, 2022, 77(4): 1105-1113.
46. Kaplan A, FitzGerald JM, Buhl R, et al. Comparing LAMA with LABA and LTRA as add-on therapies in primary care asthma management. NPJ Prim Care Respir Med, 2020, 30(1): 50.
47. Rogliani P, Ritondo BL, Calzetta L. Triple therapy in uncontrolled asthma: a network meta-analysis of phase III studies. Eur Respir J, 2021, 58(3): 2004233.
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Effects of guide-recommended treatment strategies on asthma symptom scores in moderate-to-severe asthma patients aged 5-18 years: a network meta-analysis

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