Efficacy analysis: 23 studies included (n=4280). 20 studies were of randomised design.
Adrenal suppression analysis: 13 studies included (n=245). All studies were of randomised design.
Growth effects analysis: 10 studies included, 4 short-term, 6 long-term (n=3815). All of the short-term studies and one of the long-term studies were of randomised design.
Biochemical bone markers analysis: 9 studies included (n=193). All studies were of randomised design.
Bone density analysis: 6 studies included (n=610). All included studies were of cross-sectional design.
It is unclear how many studies were included in the analysis of effects on eye, skin and leucocytes, or whether these were reviewed in a systematic way.
Efficacy: Two studies showed that doses ranging from 0.2 - 1.6 mg/day of either triamcinolone acetonide via spacer or budesonide via dry powder inhaler were all more effective than placebo; there was a plateau in response at more than 0.4 mg/day. Fluticasone propionate was effective in improving morning PEF, though the dose response curve was fairly flat between 0.1-0.8 mg/day, making it unclear which dose would be most effective. Budesonide and fluticasone were found to be equally effective in children (1 study) when given in dry powder inhalers. One study found no difference in clinical response between 1 mg/day and 2 mg/day fluticasone given via metered dose inhaler. In people with prednisone dependent severe asthma high doses of inhaled fluticasone appeared to have a more favourable effect than maintenance prednisone therapy.
Adrenal suppression: results of the meta-analysis were as follows, fluticasone (p<0.001), budesonide (p<0.001), beclomethasone (p<0.005), triamcinoline (p=0.25). The slope gradient for the dose-response relationship of fluticasone propionate was significantly higher from that for beclomethasone dipropionate, budesonide or triamcinolone acetonide.
Growth effects: For most children with mild to moderate asthma effective long term control may be attained using low doses of inhaled corticosteroids <400 microgram/day, that are not associated with any significant systemic bioactivity or effects on growth. Short term studies measuring lower leg length with knemometry have shown dose-related effects of inhaled corticosteroids. Three out of 6 medium and long term studies showed some reduction in measures of height with use of inhaled corticosteroids while the other three showed no effect.
Bone biochemical markers: All 9 studies showed some suppression of bone biochemical markers with inhaled corticosteroids.
Bone density: 2 of 6 studies showed no difference in bone density in those using corticosteroids, two studies showed a reduction in bone density mainly in women and two showed an overall reduction in bone density associated with inhaled corticosteroid use.
Effects of eyes, skin and leucocytes: results are not systematically presented.