Inhaled disodium cromoglycate (DSCG) as maintenance therapy in children with asthma: a systematic review

Marjolein J A Tasche, J H Uijen, R M Bernsen, J C de Jongste, J C van der Wouden

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

BACKGROUND: Disodium cromoglycate (DSCG) is included in the BTS guidelines on the treatment of asthma for use in children, but is now used only infrequently. We have identified and interpreted the findings of all published randomised, placebo controlled trials of DSCG in the prophylactic treatment of children with asthma.

METHODS: Several databases were searched to identify trials. Studies were included if they investigated subjects with asthma aged 0-18 years old, addressed maintenance treatment with inhaled DSCG, and were published in English. The methodological quality of the studies was assessed independently by three reviewers. The 95% confidence intervals (CI) of differences in the treatment effect for cough and wheeze between placebo and treatment with DSCG were computed. The estimates were pooled and tested for homogeneity and, to assess possible publication bias, a funnel plot was made and tested for symmetry.

RESULTS: Of the 24 randomised, placebo controlled trials identified, the methodological scores varied widely. The null hypothesis of homogeneity was rejected. Under the assumption of heterogeneity the overall CI for wheeze was 0.11 to 0.26 and for cough was 0.13 to 0.27. The overall tolerance intervals (-0.11 to 0. 48 and -0.04 to 0.43 for wheeze and cough, respectively) both included zero, so it cannot be concluded that future studies will show an effect of DSCG compared with placebo. Older studies were more often in favour of DSCG. The funnel plots suggest publication bias; small studies with negative or equal outcomes are lacking.

CONCLUSION: Given the apparent publication bias, the small overall treatment effect, and the tolerance interval including zero, there is insufficient evidence that DSCG has a beneficial effect as maintenance treatment in children with asthma.

Original languageEnglish
Pages (from-to)913-20
Number of pages8
JournalThorax
Volume55
Issue number11
Publication statusPublished - Nov 2000

Cite this

Tasche, M. J. A., Uijen, J. H., Bernsen, R. M., de Jongste, J. C., & van der Wouden, J. C. (2000). Inhaled disodium cromoglycate (DSCG) as maintenance therapy in children with asthma: a systematic review. Thorax, 55(11), 913-20.
Tasche, Marjolein J A ; Uijen, J H ; Bernsen, R M ; de Jongste, J C ; van der Wouden, J C. / Inhaled disodium cromoglycate (DSCG) as maintenance therapy in children with asthma : a systematic review. In: Thorax. 2000 ; Vol. 55, No. 11. pp. 913-20.
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abstract = "BACKGROUND: Disodium cromoglycate (DSCG) is included in the BTS guidelines on the treatment of asthma for use in children, but is now used only infrequently. We have identified and interpreted the findings of all published randomised, placebo controlled trials of DSCG in the prophylactic treatment of children with asthma.METHODS: Several databases were searched to identify trials. Studies were included if they investigated subjects with asthma aged 0-18 years old, addressed maintenance treatment with inhaled DSCG, and were published in English. The methodological quality of the studies was assessed independently by three reviewers. The 95{\%} confidence intervals (CI) of differences in the treatment effect for cough and wheeze between placebo and treatment with DSCG were computed. The estimates were pooled and tested for homogeneity and, to assess possible publication bias, a funnel plot was made and tested for symmetry.RESULTS: Of the 24 randomised, placebo controlled trials identified, the methodological scores varied widely. The null hypothesis of homogeneity was rejected. Under the assumption of heterogeneity the overall CI for wheeze was 0.11 to 0.26 and for cough was 0.13 to 0.27. The overall tolerance intervals (-0.11 to 0. 48 and -0.04 to 0.43 for wheeze and cough, respectively) both included zero, so it cannot be concluded that future studies will show an effect of DSCG compared with placebo. Older studies were more often in favour of DSCG. The funnel plots suggest publication bias; small studies with negative or equal outcomes are lacking.CONCLUSION: Given the apparent publication bias, the small overall treatment effect, and the tolerance interval including zero, there is insufficient evidence that DSCG has a beneficial effect as maintenance treatment in children with asthma.",
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Tasche, MJA, Uijen, JH, Bernsen, RM, de Jongste, JC & van der Wouden, JC 2000, 'Inhaled disodium cromoglycate (DSCG) as maintenance therapy in children with asthma: a systematic review' Thorax, vol. 55, no. 11, pp. 913-20.

Inhaled disodium cromoglycate (DSCG) as maintenance therapy in children with asthma : a systematic review. / Tasche, Marjolein J A; Uijen, J H; Bernsen, R M; de Jongste, J C; van der Wouden, J C.

In: Thorax, Vol. 55, No. 11, 11.2000, p. 913-20.

Research output: Contribution to journalReview articleAcademicpeer-review

TY - JOUR

T1 - Inhaled disodium cromoglycate (DSCG) as maintenance therapy in children with asthma

T2 - a systematic review

AU - Tasche, Marjolein J A

AU - Uijen, J H

AU - Bernsen, R M

AU - de Jongste, J C

AU - van der Wouden, J C

PY - 2000/11

Y1 - 2000/11

N2 - BACKGROUND: Disodium cromoglycate (DSCG) is included in the BTS guidelines on the treatment of asthma for use in children, but is now used only infrequently. We have identified and interpreted the findings of all published randomised, placebo controlled trials of DSCG in the prophylactic treatment of children with asthma.METHODS: Several databases were searched to identify trials. Studies were included if they investigated subjects with asthma aged 0-18 years old, addressed maintenance treatment with inhaled DSCG, and were published in English. The methodological quality of the studies was assessed independently by three reviewers. The 95% confidence intervals (CI) of differences in the treatment effect for cough and wheeze between placebo and treatment with DSCG were computed. The estimates were pooled and tested for homogeneity and, to assess possible publication bias, a funnel plot was made and tested for symmetry.RESULTS: Of the 24 randomised, placebo controlled trials identified, the methodological scores varied widely. The null hypothesis of homogeneity was rejected. Under the assumption of heterogeneity the overall CI for wheeze was 0.11 to 0.26 and for cough was 0.13 to 0.27. The overall tolerance intervals (-0.11 to 0. 48 and -0.04 to 0.43 for wheeze and cough, respectively) both included zero, so it cannot be concluded that future studies will show an effect of DSCG compared with placebo. Older studies were more often in favour of DSCG. The funnel plots suggest publication bias; small studies with negative or equal outcomes are lacking.CONCLUSION: Given the apparent publication bias, the small overall treatment effect, and the tolerance interval including zero, there is insufficient evidence that DSCG has a beneficial effect as maintenance treatment in children with asthma.

AB - BACKGROUND: Disodium cromoglycate (DSCG) is included in the BTS guidelines on the treatment of asthma for use in children, but is now used only infrequently. We have identified and interpreted the findings of all published randomised, placebo controlled trials of DSCG in the prophylactic treatment of children with asthma.METHODS: Several databases were searched to identify trials. Studies were included if they investigated subjects with asthma aged 0-18 years old, addressed maintenance treatment with inhaled DSCG, and were published in English. The methodological quality of the studies was assessed independently by three reviewers. The 95% confidence intervals (CI) of differences in the treatment effect for cough and wheeze between placebo and treatment with DSCG were computed. The estimates were pooled and tested for homogeneity and, to assess possible publication bias, a funnel plot was made and tested for symmetry.RESULTS: Of the 24 randomised, placebo controlled trials identified, the methodological scores varied widely. The null hypothesis of homogeneity was rejected. Under the assumption of heterogeneity the overall CI for wheeze was 0.11 to 0.26 and for cough was 0.13 to 0.27. The overall tolerance intervals (-0.11 to 0. 48 and -0.04 to 0.43 for wheeze and cough, respectively) both included zero, so it cannot be concluded that future studies will show an effect of DSCG compared with placebo. Older studies were more often in favour of DSCG. The funnel plots suggest publication bias; small studies with negative or equal outcomes are lacking.CONCLUSION: Given the apparent publication bias, the small overall treatment effect, and the tolerance interval including zero, there is insufficient evidence that DSCG has a beneficial effect as maintenance treatment in children with asthma.

KW - Administration, Inhalation

KW - Adolescent

KW - Anti-Asthmatic Agents/administration & dosage

KW - Asthma/drug therapy

KW - Child

KW - Child, Preschool

KW - Cromolyn Sodium/administration & dosage

KW - Data Interpretation, Statistical

KW - Humans

KW - Infant

KW - Infant, Newborn

KW - Meta-Analysis as Topic

KW - Randomized Controlled Trials as Topic

M3 - Review article

VL - 55

SP - 913

EP - 920

JO - Thorax

JF - Thorax

SN - 0040-6376

IS - 11

ER -