A mystery, missing evidence and some answers!

Contrary to what you might expect, you’ll have to wait until the end for the mystery, though in truth missing data and important questions that remain unanswered could also be labelled as that, and this is where I start.

My last blog was a round-up of new and updated reviews on asthma and I begin this one with another offering from the Cochrane Airways Group (do these people never take a day off?). It’s another tale of what we still don’t know, this time about a class of anti-inflammatory drugs called anti-leukotrines. For managing mild persistent asthma in children, low-dose inhaled corticosteroids (ICS) are recommended, but if symptoms aren’t well controlled with ICS then anti-leukotrines may be added. Almost ten years ago, a Cochrane review was published which pulled together the available evidence on the safety and effectiveness of this treatment for adults and children and found very little to go on, with just two small trials with children. Now a review has been published which looked for trials involving children (any age below 18) and finds we’re not much further on.

Exercise and asthma: what does the evidence say?

Some people with asthma find their symptoms are worse when they exercise, or restrict their physical activity for fear that this will be so. Others report that their asthma symptoms are better when they are fit. Several reviews from the Cochrane Airways Group have recently been published on aspects of exercise for people with asthma.

What’s being served up in the Cochrane Library?

The reviews are flying into the Cochrane Library quicker than balls off Murray’s racquet this week and several aces have been served! Here’s my pick of the past fortnight.

It’s all strawberries and Pimms in SW19 but in WC1 the good folk of the Cochrane Heart Group are concentrating on garlic sandwiches and tea. Now I like a nice cuppa but a garlic sandwich? Even Jamie Oliver might balk at that, but the suggestion crops up in a new review on preventing cardiovascular disease (CVD) through providing fruit and vegetables to encourage people to eat more of them, or just advising them to do so. I asked heart doctor Harry Boardman to take a look.

New evidence on benefits of formoterol for asthma, but there are still unanswered questions

Key message: The addition of new evidence to this review has shown a significant reduction in asthma-related non-fatal serious adverse events in adults with asthma who are given regular formoterol as well as inhaled steroids.

When asthma is not well controlled by low-dose inhaled corticosteroids (ICS), many asthma guidelines recommend adding another type of medicine, a long-acting beta₂-agonist, such as formoterol. These have been shown to improve lung function, quality of life and asthma symptoms but there are concerns about their safety when used regularly.

Swimming and asthma – well tolerated and beneficial, finds new review

Key message: swimming training is well tolerated in children and teens with asthma and increases physical fitness and lung function.  However, it is not known whether this is better and/or safer than other types of physical activity.

We’re putting the spotlight on asthma today. It’s World Asthma Day and the Cochrane Airways Group has just published a new review on swimming training for asthma. World Asthma Day aims to spread the message “you can control your asthma” and this year activity organizers are being encouraged to complete the sentence “It’s time to…” So does this new review suggest that we could finish that sentence with “swim”?

Treating acute asthma in the emergency department: the latest evidence

Key message: Inhaled corticosteroid therapy (ICS) reduces hospital admissions in patients with acute asthma who are not treated with oral or intravenous corticosteroids. It is unclear whether ICS reduces admissions in those given systemic corticosteroids and whether it could be used in place of systemic corticosteroids. 

Managing asthma: how does taking inhaled corticosteroids only when symptoms get worse compare with daily use?

Key message: intermittent and daily use of inhaled corticosteroids by adults and children with persistent asthma did not significantly differ in the use of rescue oral corticosteroids and the rate of adverse events. Clinicians and patients should carefully weigh up the potential benefits and harms of each treatment option.