Adding a LABA to ICS treatment in school-aged children with persistent asthma does not reduce the risk of exacerbations requiring steroid treatment, a Cochrane review confirms.

The review of 33 studies found that stepping up therapy with the addition of LABA to the usual dose of ICS improved lung function beyond that observed when remaining on the same or higher dose of ICS.

However there were no apparent benefits of asthma symptom control and use of rescue SABA.

Although not statistically significant the authors found a trend towards increased risk of exacerbations requiring hospital admissions in children treated with combination therapy.

“This trend towards increased risk of hospital admission with the addition of LABA compared with the same dose of ICS or an increased dose of ICS is a matter of concern,” the review authors wrote.

Particularly as combination therapy failed to show any benefit in reducing severity markers including the primary outcome, that is, exacerbation requiring systemic steroids,” they said.

Larger, longer-term trials in children with substantial morbidity, to clarify this issue, they authors concluded.

The Australian Asthma Handbook states that for children aged 6 and over the use of combination therapy with a LABA is not supported by the evidence.

Combination therapy is a step-up option for some children whose asthma is not well controlled by low-dose inhaled corticosteroids alone, the guidelines state.

You can read the full review here.