Diagnosing and treating asthma in paediatric patients remains challenging, with many children and adolescents remaining uncontrolled despite treatment. Selecting the most appropriate pharmacological treatment to add onto inhaled corticosteroids (ICS) in children and adolescents with asthma who remain symptomatic despite ICS can be difficult. This literature review compares the efficacy and safety of long-acting β2-agonists (LABAs), leukotriene receptor antagonists (LTRAs) and long-acting muscarinic antagonists (LAMAs) as add-on treatment to ICS in children and adolescents aged 4-17 years.A literature search identified a total of 29 studies that met the inclusion criteria, including 21 randomised controlled trials (RCTs) of LABAs versus placebo, two RCTs of LAMAs (tiotropium) versus placebo, and four RCTs of LTRA (montelukast), all as add-on to ICS. In these studies, tiotropium and LABAs provided greater improvements in lung function than LTRAs, when compared with placebo as add-on to ICS. Although exacerbation data were difficult to interpret, tiotropium reduced the risk of exacerbations requiring oral corticosteroids when added to ICS, with or without additional controllers. LABAs and LTRAs had a comparable risk of asthma exacerbations with placebo when added to ICS. When adverse events (AEs) or serious AEs were analysed, LABAs, montelukast and tiotropium had a comparable safety profile with placebo.In conclusion, this literature review provides an up-to-date overview of the efficacy and safety of LABAs, LTRAs and LAMAs as add-on to ICS in children and adolescents with asthma. Overall, tiotropium and LABAs have similar efficacy, and provide greater improvements in lung function than montelukast as add-on to ICS. All three controller options have comparable safety profiles.

中文翻译：

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噻托溴铵，长效β2-激动剂和白三烯受体拮抗剂对小儿哮喘患者肺功能和病情加重的比较。

小儿哮喘的诊断和治疗仍然充满挑战，尽管进行了治疗，许多儿童和青少年仍无法控制。选择最合适的药理治疗方法以增加哮喘儿童和青少年的吸入性糖皮质激素（ICS）的症状，尽管他们仍然有症状，尽管ICS仍然很困难。这篇文献综述比较了长效β2-激动剂（LABAs），白三烯受体拮抗剂（LTRAs）和长效毒蕈碱拮抗剂（LAMAs）作为4-17岁儿童和青少年ICS的附加治疗的有效性和安全性。文献检索确定总共29项符合纳入标准的研究，包括21项LABA与安慰剂的随机对照试验（RCT），2项LAMAs（噻托溴铵）与安慰剂的RCT和4项LTRA（孟鲁司特）的RCT。 ICS的附加组件。在这些研究中，噻托溴铵和LABA与ICS安慰剂相比，在肺功能方面比LTRA更好。尽管难以解释病情加重的数据，但噻托溴铵降低了加用ICS或不加其他控制剂时需要口服皮质类固醇激素加重的风险。与ICS相比，安慰剂使LABA和LTRA的哮喘发作风险相当。当分析不良事件（AE）或严重的AE时，LABA，孟鲁司特和噻托溴铵的安全性可与安慰剂相媲美。总而言之，本文综述了LABA，LTRA和LAMA的有效性和安全性。作为哮喘儿童和青少年中ICS的附加药物。总体而言，噻托溴铵和LABA具有相似的功效，与孟鲁司特作为ICS的附加产品相比，肺功能得到了更大的改善。所有三个控制器选件均具有可比的安全性。