{"title":"Efficacy and safety of maintenance regimens for adolescent and adult asthmatics with exercise-induced bronchospasm: Systematic review and network meta-analysis.","authors":"Irin Vichara-Anont, Lalita Lumkul, Phichayut Phinyo, Chamard Wongsa, Torpong Thongngarm","doi":"10.1016/j.jaip.2025.02.018","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Exercise-induced bronchospasm (EIB) commonly coexists with asthma. However, the data on the efficacy of maintenance therapies for asthma with EIB are scarce.</p><p><strong>Objective: </strong>This network meta-analysis assessed the comparative efficacy and safety of maintenance regimens for asthmatics with EIB.</p><p><strong>Methods: </strong>We searched PubMed, Scopus, Embase, the Cochrane Center of Controlled Trials, and Google Scholar for randomized controlled trials (RCTs) that addressed the efficacy and safety of maintenance treatments in adolescent and adult asthmatics with EIB from inception to April 2024. The primary outcome was the change in forced expiratory volume in 1 second (FEV1) post-exercise following maintenance therapy. The secondary outcome focused on treatment-related adverse events (AEs).</p><p><strong>Results: </strong>Eleven RCTs involving 1,054 patients were included. Low-dose inhaled corticosteroids (ICS)-montelukast significantly improved EIB with a mean difference (95% CI) of 14.96% (9.61, 20.31), followed by low-to-medium (LM) dose ICS-salmeterol 13.7% (8.68, 18.72), high-dose ICS 13.30% (1.34, 25.26), montelukast 11.35% (5.76, 16.95), ICS-vilanterol 9.24% (4.41,14.07), zafirlukast 8.80% (2.28, 15.32), LM-dose ICS 7.55% (3.48, 16.63), and as-needed ICS-formoterol 6.91% (2.07, 11.75). Low-dose ICS-montelukast and LM-dose ICS-salmeterol were comparably effective. There were no significant efficacy differences among ICS monotherapy, as-needed ICS-formoterol, and anti-leukotrienes. Anti-leukotrienes were inferior to ICS monotherapy in reducing asthma exacerbation. Long-acting β2-agonist (LABA)-induced tachyphylaxis may occur despite using alongside ICS.</p><p><strong>Conclusion: </strong>Low-dose ICS and as-needed ICS-formoterol were equally effective in managing asthmatics with EIB. Adding anti-leukotrienes or LABA to ICS should be considered for more severe cases, with close monitoring to assess treatment response and detect potential tachyphylaxis or AEs.</p>","PeriodicalId":51323,"journal":{"name":"Journal of Allergy and Clinical Immunology-In Practice","volume":" ","pages":""},"PeriodicalIF":8.2000,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Allergy and Clinical Immunology-In Practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jaip.2025.02.018","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ALLERGY","Score":null,"Total":0}
Efficacy and safety of maintenance regimens for adolescent and adult asthmatics with exercise-induced bronchospasm: Systematic review and network meta-analysis.
Background: Exercise-induced bronchospasm (EIB) commonly coexists with asthma. However, the data on the efficacy of maintenance therapies for asthma with EIB are scarce.
Objective: This network meta-analysis assessed the comparative efficacy and safety of maintenance regimens for asthmatics with EIB.
Methods: We searched PubMed, Scopus, Embase, the Cochrane Center of Controlled Trials, and Google Scholar for randomized controlled trials (RCTs) that addressed the efficacy and safety of maintenance treatments in adolescent and adult asthmatics with EIB from inception to April 2024. The primary outcome was the change in forced expiratory volume in 1 second (FEV1) post-exercise following maintenance therapy. The secondary outcome focused on treatment-related adverse events (AEs).
Results: Eleven RCTs involving 1,054 patients were included. Low-dose inhaled corticosteroids (ICS)-montelukast significantly improved EIB with a mean difference (95% CI) of 14.96% (9.61, 20.31), followed by low-to-medium (LM) dose ICS-salmeterol 13.7% (8.68, 18.72), high-dose ICS 13.30% (1.34, 25.26), montelukast 11.35% (5.76, 16.95), ICS-vilanterol 9.24% (4.41,14.07), zafirlukast 8.80% (2.28, 15.32), LM-dose ICS 7.55% (3.48, 16.63), and as-needed ICS-formoterol 6.91% (2.07, 11.75). Low-dose ICS-montelukast and LM-dose ICS-salmeterol were comparably effective. There were no significant efficacy differences among ICS monotherapy, as-needed ICS-formoterol, and anti-leukotrienes. Anti-leukotrienes were inferior to ICS monotherapy in reducing asthma exacerbation. Long-acting β2-agonist (LABA)-induced tachyphylaxis may occur despite using alongside ICS.
Conclusion: Low-dose ICS and as-needed ICS-formoterol were equally effective in managing asthmatics with EIB. Adding anti-leukotrienes or LABA to ICS should be considered for more severe cases, with close monitoring to assess treatment response and detect potential tachyphylaxis or AEs.
期刊介绍：
JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases.
This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders.
The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.
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