Little evidence for long-acting beta agonists in children
Experts have urged caution in use of long-acting beta agonists in children, after a Cochrane review found little evidence for their benefits.
The review found no evidence they reduced the risk of severe exacerbations when given as add-on therapy with inhaled steroids, as well as finding there was nothing to support their use as monotherapy.
Yet despite the ‘paucity of evidence', many consensus guidelines recommend long-acting [beta]-agonists as add-on therapy to inhaled steroids in children whose asthma is poorly controlled, researchers said.
The analysis of four systematic reviews in the Cochrane library also supported UK guidance warning against the use of the drugs in very young children.
But the researchers did concede it was possible that long-acting [beta]-agonists might improve quality of life when added to inhaled steroids in some cases.
Study leader Dr Amy Plint, a paediatrician in the division of emergency medicine, University of Ottawa, said: ‘While monotherapy with LABA is not recommended, guidelines differ regarding when to add LABA to steroid treatment. Long-term clinical trials are needed to adequately assess the benefits and risks of LABA in children.'
Writing in Evidence-Based Child Health, she added that clinicians needed to have a strong evidence base to support their treatment decisions.
Dr Mike Thomas, research fellow in general practice and primary care at the University of Aberdeen and GP in Minchinhampton, Gloucestershire, said UK guidelines pointed out there was no place for the drugs in children under the age of five and in older children they should only be used in combination with inhaled steroids.
Dr Dermot Ryan, a GP in Loughborough and member of the General Practice Airways Research Group, said: ‘In the over fives, if compliant with medication and with good inhaler technique, a trial of LABA is worth considering. If under five, refer to respiratory paediatrician,' he said.Little evidence for use of long-acting beta agonists in children with asthma Little evidence for use of long-acting beta agonists in children with asthma