Systematic Review Of A Randomized Controlled Trial Of ICS/LABA Combined Regimen In Step Down Therapy For Asthma

Objective:A systematic review of the efficacy and safety of a randomized controlled trial comparing the combined ICS/LABA regimen to reduce the dose of ICS versus two step-down treatments to discontinue LABA monotherapy in patients with asthma control.Methods:Randomized controlled studies related to step-down therapy of asthma were retrieved from foreign databases such as Embase,Cochrane Library,Pub Med,etc.,and Chinese databases such as CNKI,Wanfang,etc.,and all of them were exported to Endnote Literature Manager.According to the inclusion and exclusion criteria,the literatures included in the meta-analysis were screened out,the required data were extracted and presented in tables,and the extracted data were analyzed using Review Manager 5.3 software.Outcome measures included asthma exacerbation rate,ACT score,asthma control rate,and incidence of adverse events.Results:Five randomized controlled studies were included for meta-analysis.The results showed that the incidence of acute exacerbation of asthma: OR=0.89,95%CI[0.47,1.70],Test for overall effect :Z=0.35(P=0.73),P>0.05 had no statistical significance;ACT score: MD=0.29,95% confidence interval [-0.20,0.77],Test for Overall effect :Z=1.16(P=0.25),P>0.05 there was no statistical significance;Asthma control rate: complete control rate: OR=2.17,95% confidence interval [1.05,4.48],Test for overall effect :Z=2.09(P=0.04),P<0.05 the difference was statistically significant.Good control rate: OR=1.84,95% confidence interval [1.20,2.82],Test for overall effect :Z=2.79(P=0.005),P<0.05 the difference was statistically significant,in the step-down asthma treatment,the difference in asthma control rate between the combined regimen that reduced ICS dose on the basis of the original dose and the treatment group that stopped LABA and maintained the original dose of ICS was statistically significant,and the asthma control in the discontinued LABA treatment group was worse than that in the reduction group.Incidence of adverse events:OR=0.95,95%CI [0.69,1.31],Test for overall effect :Z=0.28(P=0.78),P>0.05 the difference was not statistically significant,indicating that the two descending step treatment regiments had similar safety.Conclusion:In descending stairs of ICS/LABA,the combination of ICS dose reduction was superior to LABA withdrawal monotherapy in asthma control,but there was no difference in symptom control or safety between the two.