What do systematic reviews say?

LAMA add‐on vs ICS alone

LAMA add‐on leads to lower exacerbations requiring oral corticosteroids (OCS) compared with ICS alone (high certainty).

• Long‐acting muscarinic antagonists (LAMA) added to inhaled corticosteroids (ICS) versus the same dose of ICS alone for… 2015 · Cochrane Headline outcomes only
  OR 0.65 [0.46, 0.93]
  4 studies · 2277 participants
  High

LABA/ICS vs LTRA + ICS

LABA + ICS leads to lower participants with one or more exacerbations requiring systemic… compared with LTRA + ICS (high certainty).

• Addition to inhaled corticosteroids of long‐acting beta₂‐agonists versus anti‐leukotrienes for chronic asthma 2014 · Cochrane Headline outcomes only
  RR 0.87 [0.76, 0.99]
  8 studies · 6257 participants
  High

Anti‐leukotrienes & ICS vs same‐dose ICS

Anti‐leukotrienes & ICS may leads to lower participants with one or more exacerbations requiring oral… compared with same dose ICS (low certainty).

• Addition of anti‐leukotriene agents to inhaled corticosteroids in children with persistent asthma 2013 · Cochrane Headline outcomes only
  Risk Ratio 0.8
  1 study · 279 participants
  Low

Anti‐leukotrienes & ICS vs ICS dose increase

Anti‐leukotrienes & ICS may leads to lower participants with one or more exacerbations requiring oral… compared with higher dose ICS (low certainty).

• Addition of anti‐leukotriene agents to inhaled corticosteroids in children with persistent asthma 2013 · Cochrane Headline outcomes only
  Risk Ratio 0.82
  1 study · 182 participants
  Low

Intermittent 'as needed' ICS vs daily ICS

Intermittent 'as needed' ICS showed no clear difference in patients with 1 or more exacerbations requiring oral corticosteroids… compared with daily ICS (low certainty).

• Intermittent versus daily inhaled corticosteroids for persistent asthma in children and adults 2013 · Cochrane Headline outcomes only
  RR 1.07 [0.87, 1.32]
  7 studies · 1204 participants
  Low

Intermittent ICS vs placebo

Intermittent ICS showed no clear difference in exacerbations requiring oral corticosteroids ‐ School‐age children compared with placebo (low certainty).

• Intermittent inhaled corticosteroid therapy versus placebo for persistent asthma in children and adults 2015 · Cochrane Headline outcomes only
  OR 0.57 [0.29, 1.12]
  1 study · 145 participants
  Low

Intermittent ICS vs placebo

Intermittent ICS showed no clear difference in exacerbations requiring oral corticosteroids ‐ adults compared with placebo (low certainty).

• Intermittent inhaled corticosteroid therapy versus placebo for persistent asthma in children and adults 2015 · Cochrane Headline outcomes only
  OR 0.1 [0.01, 1.95]
  1 study · 240 participants
  Low

Intermittent ICS vs placebo

Intermittent ICS probably leads to lower exacerbations requiring oral corticosteroids compared with placebo (moderate certainty).

• Intermittent inhaled corticosteroid therapy versus placebo for persistent asthma in children and adults 2015 · Cochrane Headline outcomes only
  OR 0.48 [0.31, 0.73]
  4 studies · 490 participants
  Moderate

Inhaled corticosteroids vs systemic corticosteroids

ICS showed no clear difference in hospital admission compared with systemic corticosteroids (low certainty).

• Early use of inhaled corticosteroids in the emergency department treatment of acute asthma 2012 · Cochrane Headline outcomes only
  OR 0.56 [0.25, 1.24]
  10 studies · 763 participants
  Low

Inhaled corticosteroids vs placebo

• Inhaled corticosteroids versus placebo for stable chronic obstructive pulmonary disease 2023 · Cochrane Headline outcomes only
  no estimate extracted
  5 studies · 10316 participants
  Moderate

Inhaled corticosteroids vs placebo

• Inhaled corticosteroids versus placebo for stable chronic obstructive pulmonary disease 2023 · Cochrane Headline outcomes only
  no estimate extracted
  5 studies · 2507 participants
  Moderate

Inhaled corticosteroids vs placebo

• Inhaled corticosteroids versus placebo for stable chronic obstructive pulmonary disease 2023 · Cochrane Headline outcomes only
  no estimate extracted
  6 studies · 12502 participants
  Moderate

Inhaled corticosteroids vs placebo

Summary of findings table ‐ ICS showed no clear difference in mortality compared with placebo (moderate certainty).

• Inhaled corticosteroids versus placebo for stable chronic obstructive pulmonary disease 2023 · Cochrane Headline outcomes only
  OR 0.94 [0.84, 1.07]
  10 studies · 16636 participants
  Moderate

Inhaled corticosteroids vs placebo

Summary of findings table ‐ ICS may leads to higher pneumonia compared with placebo (low certainty).

• Inhaled corticosteroids versus placebo for stable chronic obstructive pulmonary disease 2023 · Cochrane Headline outcomes only
  OR 1.38 [1.02, 1.88]
  9 studies · 14831 participants
  Low

Inhaled corticosteroids vs placebo

Summary of findings table ‐ ICS probably leads to higher oropharyngeal candidiasis compared with placebo (moderate certainty).

• Inhaled corticosteroids versus placebo for stable chronic obstructive pulmonary disease 2023 · Cochrane Headline outcomes only
  OR 2.66 [1.91, 3.68]
  7 studies · 5547 participants
  Moderate

Triple therapy vs LABA/LAMA combination

The review found no eligible studies for this question.

• Inhaled corticosteroids with combination inhaled long‐acting beta2‐agonists and long‐acting muscarinic antagonists for… 2023 · Cochrane Headline outcomes only
  no estimate extracted
  Studies not reported
  No studies found

Triple therapy vs LABA/LAMA combination

Triple therapy may leads to lower moderate‐to‐severe exacerbations (rate) compared with LABA/LAMA combination (low certainty).

• Inhaled corticosteroids with combination inhaled long‐acting beta2‐agonists and long‐acting muscarinic antagonists for… 2023 · Cochrane Headline outcomes only
  RR 0.74 [0.67, 0.81]
  4 studies · 15397 participants
  Low

Triple therapy vs LABA/LAMA combination

Triple therapy may leads to lower severe exacerbations (rate) compared with LABA/LAMA combination (low certainty).

• Inhaled corticosteroids with combination inhaled long‐acting beta2‐agonists and long‐acting muscarinic antagonists for… 2023 · Cochrane Headline outcomes only
  RR 0.75 [0.67, 0.84]
  3 studies · 14131 participants
  Low

Triple therapy vs LABA/LAMA combination

Triple therapy leads to higher respiratory HRQoL measured by SGRQ, ≥ 4‐point decrease from baseline… compared with LABA/LAMA combination (high certainty).

• Inhaled corticosteroids with combination inhaled long‐acting beta2‐agonists and long‐acting muscarinic antagonists for… 2023 · Cochrane Headline outcomes only
  OR 1.35 [1.26, 1.45]
  3 studies · 14070 participants
  High

Triple therapy vs LABA/LAMA combination

Triple therapy probably leads to higher pneumonia (labelled as an SAE) compared with LABA/LAMA combination (moderate certainty).

• Inhaled corticosteroids with combination inhaled long‐acting beta2‐agonists and long‐acting muscarinic antagonists for… 2023 · Cochrane Headline outcomes only
  OR 1.74 [1.39, 2.18]
  4 studies · 15412 participants
  Moderate