Trial reportThe New England journal of medicine2010
Step-up therapy for children with uncontrolled asthma receiving inhaled corticosteroids.
Trial report in The New England journal of medicine, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 151 papers, 16 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Childhood Asthma Research and Education (CARE) Network Trial - Best Add-On Therapy Giving Effective Response (BADGER)
Prescribing Asthma Controller Medication According to Gene Status to Improve Quality of Life in Young People With Asthma
PrecISE (Precision Interventions for Severe and/or Exacerbation-Prone Asthma) Network Study
Who cites it
151 citing papers in PubMed, 16 syntheses or guidelines pooled it, 441 citations in OpenAlex.
- Establishing the best step-up treatments for children with uncontrolled asthma despite inhaled corticosteroids: the EINSTEIN systematic review, network meta-analysis and cost-effectiveness analysis using individual participant data.Health technology assessment (Winchester, England) · 2025Pooled it
- Best step-up treatments for children with uncontrolled asthma: a systematic review and network meta-analysis of individual participant data.The European respiratory journal · 2023Pooled it
- Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children.The Cochrane database of systematic reviews · 2022Pooled it
- Genome-wide association studies of exacerbations in children using long-acting beta2-agonists.Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology · 2021Pooled it
- Uncovering Outcome Disparities of βJournal of the National Medical Association · 2021Pooled it
- Inhaled steroids with and without regular formoterol for asthma: serious adverse events.The Cochrane database of systematic reviews · 2019Pooled it
- Childhood asthma exacerbations and the Arg16 β2-receptor polymorphism: A meta-analysis stratified by treatment.The Journal of allergy and clinical immunology · 2016Pooled it
- Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children.The Cochrane database of systematic reviews · 2016Pooled it
- Addition of long-acting beta2-agonists to inhaled corticosteroids for chronic asthma in children.The Cochrane database of systematic reviews · 2015Pooled it
- Stopping long-acting beta2-agonists (LABA) for children with asthma well controlled on LABA and inhaled corticosteroids.The Cochrane database of systematic reviews · 2015Pooled it
- Addition to inhaled corticosteroids of long-acting beta2-agonists versus anti-leukotrienes for chronic asthma.The Cochrane database of systematic reviews · 2014Pooled it
- Addition of anti-leukotriene agents to inhaled corticosteroids in children with persistent asthma.The Cochrane database of systematic reviews · 2013Pooled it
- A systematic review with attempted network meta-analysis of asthma therapy recommended for five to eighteen year olds in GINA steps three and four.BMC pulmonary medicine · 2012Pooled it
- Anti-leukotriene agents compared to inhaled corticosteroids in the management of recurrent and/or chronic asthma in adults and children.The Cochrane database of systematic reviews · 2012Pooled it
- Asthma and other recurrent wheezing disorders in children (chronic).BMJ clinical evidence · 2012Pooled it
- Canadian Thoracic Society 2012 guideline update: diagnosis and management of asthma in preschoolers, children and adults.Canadian respiratory journalGuideline
- Efficacy, Safety, and Systemic Exposure of Once-Daily Indacaterol Acetate in Pediatric Asthma: A Randomized, Double-Blind, Controlled Dose-Finding Study.Clinical drug investigation · 2023Trial
- Step-Up Therapy in Black Children and Adults with Poorly Controlled Asthma.The New England journal of medicine · 2019Trial
- Individualized therapy for persistent asthma in young children.The Journal of allergy and clinical immunology · 2016Trial
- A 12-week open-label, randomized, controlled trial and 24-week extension to assess the efficacy and safety of fluticasone propionate/formoterol in children with asthma.Therapeutic advances in respiratory disease · 2016Trial
91 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
18 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundFor children who have uncontrolled asthma despite the use of low-dose inhaled corticosteroids (ICS), evidence to guide step-up therapy is lacking.
methodsWe randomly assigned 182 children (6 to 17 years of age), who had uncontrolled asthma while receiving 100 microg of fluticasone twice daily, to receive each of three blinded step-up therapies in random order for 16 weeks: 250 microg of fluticasone twice daily (ICS step-up), 100 microg of fluticasone plus 50 microg of a long-acting beta-agonist twice daily (LABA step-up), or 100 microg of fluticasone twice daily plus 5 or 10 mg of a leukotriene-receptor antagonist daily (LTRA step-up). We used a triple-crossover design and a composite of three outcomes (exacerbations, asthma-control days, and the forced expiratory volume in 1 second) to determine whether the frequency of a differential response to the step-up regimens was more than 25%.
resultsA differential response occurred in 161 of 165 patients who were evaluated (P<0.001). The response to LABA step-up therapy was most likely to be the best response, as compared with responses to LTRA step-up (relative probability, 1.6; 95% confidence interval [CI], 1.1 to 2.3; P=0.004) and ICS step-up (relative probability, 1.7; 95% CI, 1.2 to 2.4; P=0.002). Higher scores on the Asthma Control Test before randomization (indicating better control at baseline) predicted a better response to LABA step-up (P=0.009). White race predicted a better response to LABA step-up, whereas black patients were least likely to have a best response to LTRA step-up (P=0.005).
conclusionsNearly all the children had a differential response to each step-up therapy. LABA step-up was significantly more likely to provide the best response than either ICS or LTRA step-up. However, many children had a best response to ICS or LTRA step-up therapy, highlighting the need to regularly monitor and appropriately adjust each child's asthma therapy. (ClinicalTrials.gov number, NCT00395304.)
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.