الفهرس 
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Abstract
A systematic review is a literature review focused on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Systematic reviews of high-quality randomized controlled trials are crucial to evidence-based medicine.
Asthma is an important chronic airway disease worldwide, and its prevalence is increasing in all regions. The goal of asthma management is to achieve optimum disease control, so different measures such as clinical assessment (symptoms and quality of life), functional parameters (spirometry), and biomarker of inflammation are used to evaluate asthma control.
The recognition that asthma is a chronic inflammatory disorder of the airways has resulted in an increased emphasis on the use of anti-inflammatory drugs. Anti-inflammatory drugs reduce inflammation and prevent permanent injury in the lungs and also help prevent asthma attacks from occurring, so anti-inflammatory drugs are the corner stone of asthma treatment.
The aim of the present study was to assess when to begin and when to stop anti inflammatory therapy in asthmatic children.
We started by searching of published studies was performed in the electronic database in the last 20 years available through MEDLINE pubmed, MEDLINE Ovid and Cochrane controlled trials register.
Searching the electronic data base for literature review identified 65 Published studies, 55 articles of them were excluded (15 of them excluded by title and abstract and 40 of them excluded after full texts) and the other 10 studies are included in our study.
This systematic review reported that anti-inflammatory drugs are the corner stone in asthma treatment so we must start treatment of asthmatic children with anti-inflammatory drugs as soon as possible. Early treatment results in significantly better improvements in airway function, exercise tolerance, lower risk of exacerbations and less use of additional asthma medications as well as needed reliever medication. These obvious benefits can be achieved with significantly lower maintenance doses of ICS thereby further reducing the risks of long-term side effects.
Due to long-term side effects and cost effectiveness of anti-inflammatory drugs especially ICS in treatment of asthmatic children so step-down, tapering and discontinuing inhaled corticosteroids once good asthma control is achieved is recommended but there are controversies about duration after which stepping-down and withdrawal ICS is done, as some studies suggested that the dose of ICS can be decreased by 50% every 2-3 months after the initial treatment and were able to successfully withdraw the treatment in 52% of patients, who subsequently remained symptom-free. However, their followup period was only 2.3±0.5 months and on the other side there was study suggesting longer duration for weaning off average of 12.6 months (9-18 months) as once sustained control had been maintained for a period ranging from 9 to 18 months, gradual withdrawal was attempted. The dosage was reduced by 50–100 microg each time, at intervals of 3 month. Finally, patients received ICS dose every other day and the drug was then completely withdrawn. There was another study suggesting that periodic inhaled steroid use is becoming more acceptable. patients had less severe asthma and experienced better subsequent clinical outcomes than those who were supposed to use inhaled corticosteroids on a daily basis as the NHLBI guidelines,2007 state that periodic or seasonal treatment is an acceptable option for some children and should be considered as step down therapy for patients being removed from daily inhaled corticosteroids.
In all researched RCT studies, there is a defect in
answering the question of when to begin and when to stop anti-inflammatory drugs in asthmatic children so we recommend doing more RCTs researches with much longer period of study and a larger sample would be required to assess the long-term beneficial effects of inhaled corticosteroid therapy and subsequent withdrawal, on preventing the progress of childhood asthma into adult life.