Seven RCTs (1,204 adults and children) were included.
The authors stated that, overall, the RCTs were of a high quality. On the Jadad scale, 5 RCTs scored 5 points and the other 2 RCTs scored 4 points. All 7 RCTs had blinded treatment allocation. Methodological problems included the use of unvalidated scales to measure outcomes, the lack of sample size calculations and incomplete reporting. Inter-observer agreement for potentially relevant studies from the computer search was moderate (K=0.57). Inter-observer agreement for screening of full texts was 100% (K=1).
Relapse rates: there was no statistically-significant difference in relapse rates between ICS and OCS at 7 to 10 days or at 16 days. Overall, there was a low rate of relapse rates (pooled rate 106 out of 684, i.e. 15%). The OR at 7 to 10 days (4 RCTs) was 1.0 (95% CI: 0.66, 1.52); no significant heterogeneity was detected (P=0.88). The OR at 16 days (2 RCTs) was 1.26 (95% CI: 0.80, 1.99); no significant heterogeneity was detected (P=0.88).
Admission rates (2 RCTs): neither RCT reported any admissions.
Pulmonary function tests: there was no statistically-significant difference in absolute peak expiratory flow rate (PEFR) between ICS and OCS at 7 to 10 days. The PEFR was 10 L/minute (95% CI: -6, +26) in the ICS-treated group; no significant heterogeneity was detected (P=0.19). At 20 to 24 days, ICS improved PEFR compared with OCS, but the authors considered this improvement to be of no clinical significance. The difference (2 RCTs) was 15 L/minute (95% CI: 2, 29); no significant heterogeneity was detected (P=0.41).
Beta-agonist use: there was no statistically-significant difference in beta-agonist use at 7 to 10 days between ICS and OCS. The WMD in beta-agonist use (2 RCTs) was 0.1 more puffs per day (95% CI: -0.4, +0.7) with ICS.
Quality of life: there was no statistically-significant difference in quality of life between ICS and OCS. The WMD in quality of life (2 RCTs) was -0.1 (95% CI: -0.7, +0.5).
Asthma symptoms and side-effects: there were insufficient data to assess asthma symptoms and side-effects.