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Extrafine HFA-beclomethasone-formoterol vs. nonextrafine combination of an inhaled corticosteroid and a long acting β2-agonist in patients with persistent asthma: A systematic review and meta-analysis.
Liu, T, Yang, D, Liu, C
PloS one. 2021;(9):e0257075
Abstract
OBJECTIVE Airway inflammation in asthma involves not only the central airways but extends to peripheral airways. Lung deposition may be key for an appropriate treatment of asthma. We compared the clinical effects of extrafine hydrofluoroalkane (HFA)-beclomethasone-formoterol (BDP-F) versus equipotent doses of nonextrafine combination of an inhaled corticosteroid and a long acting β2-agonist (ICS-LABA) in asthma. METHODS We identified eligible studies by a comprehensive literature search of PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL). Data analysis was performed with the Review Manager 5.3.5 software (Cochrane IMS, 2014). RESULTS A total of 2326 patients with asthma from ten published randomized controlled trials (RCTs) were enrolled for analysis. Change from baseline in morning pre-dose peak expiratory flow (PEF), evening pre-dose PEF and forced expiratory volume in one second (FEV1) were detected no significant differences between extrafine HFA-BDP-F and nonextrafine ICS-LABAs (p = 0.23, p = 0.99 and p = 0.23, respectively). Extrafine HFA-BDP-F did not show any greater benefit in forced expiratory flow between 25% and 75% of forced vital capacity (FEF25-75%), the parameter concerning peripheral airways (MD 0.03L/s, p = 0.65; n = 877). There were no substantial differences between interventions in fractional exhaled nitric oxide (FeNO) levels or in its alveolar fraction. The overall analysis showed no significant benefit of extrafine HFA-BDP-F over nonextrafine ICS-LABA in improving Asthma Control Test (ACT) score (p = 0.30) or decreasing the number of puffs of rescue medication use (p = 0.16). Extrafine HFA-BDP-F did not lead to less exacerbations than nonextrafine ICS-LABA (RR 0.61, 95% CI: 0.31 to 1.20; I2 = 0; p = 0.15). CONCLUSION Enrolled RCTs of extrafine HFA-BDP-F have demonstrated no significant advantages over the equivalent combination of nonextrafine ICS-LABA in improving pulmonary function concerning central airways or peripheral airways, improving asthma symptom control or reducing exacerbation rate.
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The Prevalence of Asthma among Iranian Children and Adolescent: A Systematic Review and Meta-Analysis.
Rahimian, N, Aghajanpour, M, Jouybari, L, Ataee, P, Fathollahpour, A, Lamuch-Deli, N, Kooti, W, Kalmarzi, RN
Oxidative medicine and cellular longevity. 2021;:6671870
Abstract
BACKGROUND Asthma is an important reason for hospitalization in children aged under five years. Information about the current status of asthma in Iranian children can help the Iranian health sector plan carefully and prevent asthma incidence by educating the families. The present systematic review and meta-analysis is aimed at estimating asthma prevalence in Iranian children and adolescents. METHOD Data were found using keywords such as prevalence, epidemiology, asthma, adolescent, children, pediatrics, Iran in Web of Science, Scopus, PubMed, Cochrane, and Embase databases. Three national databases, including Magiran, Barakat Pharmed Co (Iran medex), and Scientific Information Databank (SID) were searched until 1 October 2020. Cross-sectional and original studies were included in the study, and then, quality assessment was done using the National Institutes of Health's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A pooled estimated prevalence of asthma was calculated using Der Simonian-Laird random model. Egger's test was used to evaluate publication bias. The data were analyzed using the STATA software version 16. RESULTS 30 studies were selected and investigated. The prevalence of asthma in children and adolescents was 6% and 8%, and the prevalence in boys and girls was 9% and 8%, respectively. Among the asthma symptoms, wheezing had the most prevalence (17% in children and 19% in adolescents) and sleep disturbance had the lowest prevalence (6% in children and 6% in adolescents). CONCLUSION The prevalence of asthma in Iranian children and adolescents is lower than in the world. Existing strategies should be pursued followed. Also, guidelines for asthma control and prevention should be considered in the future.
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Breastfeeding and wheeze-related outcomes in high-risk infants: A systematic review and meta-analysis.
Harvey, SM, Murphy, VE, Whalen, OM, Gibson, PG, Jensen, ME
The American journal of clinical nutrition. 2021;(6):1609-1618
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Abstract
BACKGROUND The risk of wheezing is high in infancy and is heightened in infants with a family history of asthma/atopy. The role of breastfeeding in influencing respiratory health for these high-risk infants is unclear. OBJECTIVES To systematically appraise evidence for the association between breastfeeding and wheeze incidences and severity in high-risk infants. METHODS Studies identified through electronic databases and reference lists were eligible if they assessed breastfeeding and respiratory outcomes in infants with a family history of asthma/atopy. The primary outcome was wheeze incidences in the first year of life. Secondary outcomes were wheeze incidences in the first 6 months of life, indicators of wheeze severity (recurrent wheeze, health-care utilization, and medication use), and other wheeze-related outcomes [bronchiolitis, pneumonia, croup, and incidence of lower respiratory tract infection (LRTI)] up to 12 months old. Meta-analyses were conducted where possible. RESULTS Of 1843 articles screened, 15 observational studies met the inclusion criteria. Breastfeeding was associated with 32% reduced odds of wheezing during the first year of life (ever vs. never: OR, 0.68; 95% CI: 0.53, 0.88; n = 9 studies); this association was even stronger in the first 6 months (OR, 0.45; 95% CI: 0.27, 0.75; n = 5 studies). Breastfeeding for a "longer" versus "shorter" time (approximately longer vs. shorter than 3 months) was associated with 50% reduced odds of wheezing at the age of 6 months (OR, 0.50; 95% CI: 0.39, 0.64; n = 3 studies). CONCLUSIONS Breastfeeding was associated with reduced odds of wheezing in high-risk infants, with the strongest protection in the first 6 months. More research is needed to understand the impact of breastfeeding intensity on wheezing and to examine additional respiratory outcomes, including wheeze severity. This review was registered at PROSPERO as CRD42019118631.
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Vitamin D can safely reduce asthma exacerbations among corticosteroid-using children and adults with asthma: a systematic review and meta-analysis of randomized controlled trials.
Chen, Z, Peng, C, Mei, J, Zhu, L, Kong, H
Nutrition research (New York, N.Y.). 2021;:49-61
Abstract
Previous studies have failed to draw a consistent conclusion over the effect of vitamin D administration on asthma. We hypothesized that vitamin D supplementation could improve the clinical efficacy of corticosteroids in patients with asthma as measured by exacerbations, Asthma Control Test (ACT) score, and lung function in order to maintain asthma control. We searched Web of Science, PubMed, the Cochrane Library, and ScienceDirect up through January 20, 2021 for randomized controlled trials analyzing the effect of vitamin D supplementation on asthma exacerbation. Studies were limited to patients with moderate to severe asthma who were treated with corticosteroids. We identified 12 studies involving 1,543 participants in this meta-analysis. Vitamin D supplementation significantly reduced the risk of asthma exacerbation (pooled risk ratio (RR) 0.70, 95% confidence interval (CI), 0.59, 0.83; P < .05). The pooled RR of the ACT score was 0.04 (95% CI, -0.19, 0.27; P > .05). The pooled standardized mean difference in vitamin D levels was 1.07 (95% CI, 0.77, 1.38; P < .05), and in the percentage of forced expiratory volume in one second was -0.02 (95% CI, -0.13, 0.09; P > .05). The pooled RR of adverse events was 1.06 (95% CI, 0.89, 1.25; P > .05). We performed subgroup analysis and meta-regression of serum vitamin D levels but found no source of heterogeneity. Vitamin D supplementation safely reduced the rate of asthma exacerbation but did not improve ACT score or lung function among patients with asthma treated with corticosteroids.
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Dietary meat intake and risk of asthma in children: evidence from a meta-analysis.
Zhang, D, Cao, L, Wang, Z, Wang, Z
Medicine. 2020;(1):e18235
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Abstract
BACKGROUND Many studies have been reported that dietary meat intake may be associated with the risk of asthma in children, but the results are inconsistent. Therefore, we performed a meta-analysis to evaluate the effect of meat on the risk of asthma in children. METHODS The databases PubMed, Embase, and Web of Science were searched. Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated with random-effect model using Stata software. RESULTS A total of 9 articles were included in this meta-analysis. Results from our study suggest that dietary meat intake 3 or more times per week compared with never/occasionally intake has no significant association with asthma risk among children (OR = 1.27, 95% CI = 0.80-2.01, P = .308). Similarly, daily intake of meat did not affect the risk of asthma in children when compared with never/occasionally intake (OR = 1.13, 95% CI = 0.93-1.37, P = 0.234). In addition, no publication biases were detected in our meta-analysis. CONCLUSION Dietary meat intake most probably is not a risk factor for asthma in children. Due to some limitations that exist in our study, more studies are needed to further assess the association between meat intake and asthma risk in children.
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Does vitamin D supplementation reduce asthma exacerbations?
Jaura, J, Kelsberg, G, Safranek, S
The Journal of family practice. 2020;(4):E4-E6
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Vitamin D receptor gene polymorphism and susceptibility to asthma: Meta-analysis based on 17 case-control studies.
Makoui, MH, Imani, D, Motallebnezhad, M, Azimi, M, Razi, B
Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 2020;(1):57-69
Abstract
BACKGROUND During the last decade, several studies have evaluated the potential association between vitamin D receptor (VDR) gene polymorphism and susceptibility to asthma. In spite of valuable findings, the results are still contradictory. Therefore, a comprehensive meta-analysis not only solves discrepancies but provides a clue for future projects. OBJECTIVE This meta-analysis was performed to identify whether VDR gene polymorphisms (FokI (rs2228570) or TaqI (rs731236) or BsmI (rs1544410) or ApaI (rs7975232)) play a role in the risk of asthma. METHODS Electronic search of Web of Science, Scopus, and PubMed databases were systematically conducted from their inception until June 2019, to identify all published studies. Eligibility of the studies was confirmed by precise inclusion and exclusion criteria, and the resultant studies were analyzed. RESULTS A total of 17 studies concerning VDR gene polymorphisms and asthma risk were included in this meta-analysis. The results of pooled analysis indicated a statistically significant association between FokI SNP (dominant model [OR = 0.78, 95% CI, 0.62-0.98, random effect model] and allelic model [OR = 0.81, 95% CI, 0.67-0.98, random effect model]) and TaqI SNP (homozygote contract model [OR = 0.70, 95% CI, 0.54-0.89]) with asthma risk. Moreover, subgroup analysis showed that ethnicity influences asthma risk in Asian, African, and American populations. The sensitivity analyses confirmed the stability of the results. CONCLUSION This meta-analysis suggests that VDR gene polymorphism is associated with the risk of asthma.
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Association of maternal folate intake during pregnancy with infant asthma risk.
Li, W, Xu, B, Cao, Y, Shao, Y, Wu, W, Zhou, J, Tan, X, Wu, X, Kong, J, Hu, C, et al
Scientific reports. 2019;(1):8347
Abstract
Several studies assessed the association of maternal folate intake with infant asthma risk, but the findings are controversial. We performed a meta-analysis to clarify the association between maternal folate intake and infant asthma risk. PubMed and SCOPUS databases were searched for related studies published until August 2018. Fixed-effects models were applied to pool relative risks (RRs) and their corresponding 95% confidence intervals (CIs) due to the low heterogeneity. We also adopted generalized least-squares trend (GLST) estimation for the dose-response analysis. In our study, a total of 10 studies with maternal folate intake and 5 studies with blood folate concentration were included. We found that maternal folate intake during pregnancy was significantly related to the risk of infant asthma (RR = 1.11; 95% CI = 1.06-1.17). Similar results were found for geographic region from Europe (RR = 1.08; 95% CI = 1.01-1.16) and North America (RR = 1.20; 95% CI = 1.11-1.30) in subgroup analyses. Meanwhile, the dose-response analysis showed a linear relationship between maternal folic acid intake during pregnancy and infant asthma risk. This meta-analysis indicates that maternal folate intake during pregnancy could increase infant asthma risk. Therefore, the adverse effect of folic acid on infant asthma should not be ignored when it is supplemented during pregnancy to prevent birth defects.
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Association between soft drinks consumption and asthma: a systematic review and meta-analysis.
Al-Zalabani, AH, Noor Elahi, I, Katib, A, Alamri, AG, Halawani, A, Alsindi, NM, Almatrafi, M, Wesselius, A, Stewart, KFJ
BMJ open. 2019;(10):e029046
Abstract
OBJECTIVES To carry out meta-analysis and systematic review on the association between soft drinks consumption and asthma prevalence among adults and children. DESIGN Systematic review and meta-analysis of observational research. DATA SOURCES Medline, Scopus, ISI Web of Science and the Cochrane Library were searched up to December 2018. ELIGIBILITY CRITERIA We included observational studies investigating the association between soft drinks consumption (including maternal consumption during pregnancy) and asthma or wheeze. DATA EXTRACTION AND SYNTHESIS Data were extracted by one author and reviewed independently by two other authors. The most adjusted estimate from each original study was used in the meta-analysis. Meta-analysis was conducted using random-effects model. The quality of studies was assessed using the Newcastle-Ottawa scale and heterogeneity was evaluated using I2 statistic. RESULTS Of 725 publications originally identified, 19 were included in this systematic review, including 3 cohort studies and 16 cross-sectional studies. Ten articles reported on children up to 18 years, 5 articles on adults (>18 years) and 2 articles on prenatal exposure. In total, 468 836 participants were included, with more than 50 000 asthma cases. Soft drinks consumption was associated with significantly increased odds of asthma in both adults (OR=1.37; 95% CI, 1.23 to 1.52) and children (OR=1.14; 95% CI, 1.06 to 1.21). Prenatal exposure had marginally statistically significant association (OR=1.11; 95% CI, 1.00 to 1.23) with asthma in children. In subgroup analysis for childhood exposure, the association persists for sugar-sweetened soft drinks but not for carbonated drinks. CONCLUSION Our findings show a positive association between soft drinks consumption and asthma prevalence, mostly from cross-sectional studies. Therefore, more longitudinal research is required to establish causality.
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The role of oral magnesium supplements for the management of stable bronchial asthma: a systematic review and meta-analysis.
Abuabat, F, AlAlwan, A, Masuadi, E, Murad, MH, Jahdali, HA, Ferwana, MS
NPJ primary care respiratory medicine. 2019;(1):4
Abstract
Asthma is a chronic lung disease characterized by airway inflammation and hyper-responsiveness of airway smooth muscles. There is growing evidence that magnesium may have a role in managing asthma through its dual effect as an anti-inflammatory and bronchodilating agent. To assess the efficacy of oral magnesium supplements in chronic asthmatic patients. In addition to searching through Clinicaltrials.gov/ and references for oral magnesium supplement studies, we performed a database search in Medline, CINAHL, CENTRAL, and Embase. We contacted the authors of the included trials to ask for additional information. We included randomized controlled trials that compared oral magnesium supplements versus placebo, in addition to standard asthma treatment in mild-moderate asthmatic adults and children (older than 6 years). Two reviewers independently performed the study selection, data abstraction, and the assessment of the risk of bias. Eight trials at moderate risk of bias enrolling a total of 917 patients were included. Oral magnesium improved FEV1 at week 8 (5.69 (L/min); 95% CI: 1.92, 9.46; I2: 45%). There was no significant improvement in FEV1 at other follow up periods. There was no significant change in FVC, Methacholine challenge test, the frequency of bronchodilator use, or symptoms score. There were no data on mortality or quality of life. Oral magnesium supplements may lead to improvement in FEV1 that was only demonstrated at eight weeks; but no effect on any other outcome. Until future evidence emerges, oral magnesium cannot be recommended as adjuvants to standard treatment for mild to moderate asthmatic individuals.