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When should a long acting β agonist be added to an inhaled corticosteroid?
  1. A E Tattersfield
  1. Correspondence to:
    Professor A E Tattersfield
    Division of Respiratory Medicine, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK;

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Evidence suggests that adding a long acting β agonist provides more clinical benefit than doubling the dose of an inhaled steroid even for relatively low doses of inhaled corticosteroid

Meta-analyses are a mixed blessing; they can be helpful and they can be misleading,1–3 and meta-analyses of studies in asthma are no exception.4 They are misleading when they fail to make clear that the conclusions only pertain to patients fulfilling the inclusion and exclusion criteria for the original studies. To suggest that they either confirm what everyone knows or provide conclusions, from somewhat dubious sources with spurious precision, may be unduly cynical. Nevertheless, it appears to be difficult to identify questions where a meta-analysis is able to provide important new insights into asthma management.

Professor Beasley’s group in New Zealand has used meta-analysis in the past to look at the dose-response relation for inhaled budesonide and fluticasone.5,6 The two meta-analyses included all studies that had assessed at least two doses of the inhaled corticosteroid in addition to placebo. The conclusion of the analyses was that, in …

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