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End of the line for cromoglycate?

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Inhaled disodium cromoglycate has been used as maintenance treatment for asthma for over 30 years and is recommended in current guidelines. Nevertheless, in clinical practice over the last 10 years it has been largely replaced by inhaled steroids. Now a systematic review by workers in the Netherlands (MJA Tasche and colleagues. Thorax2000;55:913–20) may be the coup de grâce.  The review included 24 randomised controlled trials of disodium cromoglycate in children. Overall, methodology was assessed as weak, especially as regards treatment compliance, selection and inclusion, and statistics and analysis. Funnel plots indicated publication bias with missing small, negative studies. Treatment effects on wheeze and cough were small and tolerance intervals for both included zero. The more recent studies showed results less favourable to disodium cromoglycate. The authors conclude that disodium cromoglycate has not been proved to be better than placebo in the maintenance treatment of childhood asthma and that its promotion as a first line prophylactic treatment is no longer justified.