Scolaris Content Display Scolaris Content Display

Related content

Jump to:

Related reviews and protocols

Topics

Topics

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Navigate to figure in ReviewOpen in new tab

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Navigate to figure in ReviewOpen in new tab

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Navigate to figure in ReviewOpen in new tab

Comparison 1 Stable state bronchiectasis (6 months or less), Outcome 1 Lung function (spirometry indices).
Figures and Tables -
Analysis 1.1

Comparison 1 Stable state bronchiectasis (6 months or less), Outcome 1 Lung function (spirometry indices).

Navigate to figure in ReviewOpen in new tab

Comparison 1 Stable state bronchiectasis (6 months or less), Outcome 2 Lung function (other indices).
Figures and Tables -
Analysis 1.2

Comparison 1 Stable state bronchiectasis (6 months or less), Outcome 2 Lung function (other indices).

Navigate to figure in ReviewOpen in new tab

Comparison 1 Stable state bronchiectasis (6 months or less), Outcome 3 Clinical severity indices.
Figures and Tables -
Analysis 1.3

Comparison 1 Stable state bronchiectasis (6 months or less), Outcome 3 Clinical severity indices.

Navigate to figure in ReviewOpen in new tab

Comparison 1 Stable state bronchiectasis (6 months or less), Outcome 4 Exacerbations.
Figures and Tables -
Analysis 1.4

Comparison 1 Stable state bronchiectasis (6 months or less), Outcome 4 Exacerbations.

Navigate to figure in ReviewOpen in new tab

Comparison 1 Stable state bronchiectasis (6 months or less), Outcome 5 Sputum and biomarkers characteristics.
Figures and Tables -
Analysis 1.5

Comparison 1 Stable state bronchiectasis (6 months or less), Outcome 5 Sputum and biomarkers characteristics.

Navigate to figure in ReviewOpen in new tab

Comparison 1 Stable state bronchiectasis (6 months or less), Outcome 6 Pseudomonas aeruginosa colonisation.
Figures and Tables -
Analysis 1.6

Comparison 1 Stable state bronchiectasis (6 months or less), Outcome 6 Pseudomonas aeruginosa colonisation.

Navigate to figure in ReviewOpen in new tab

Comparison 1 Stable state bronchiectasis (6 months or less), Outcome 7 St George HRQoL (end of study minus baseline).
Figures and Tables -
Analysis 1.7

Comparison 1 Stable state bronchiectasis (6 months or less), Outcome 7 St George HRQoL (end of study minus baseline).

Navigate to figure in ReviewOpen in new tab

Comparison 2 Stable state (> 6 months), Outcome 1 Lung function indices.
Figures and Tables -
Analysis 2.1

Comparison 2 Stable state (> 6 months), Outcome 1 Lung function indices.

Navigate to figure in ReviewOpen in new tab

Comparison 2 Stable state (> 6 months), Outcome 2 Exacerbations.
Figures and Tables -
Analysis 2.2

Comparison 2 Stable state (> 6 months), Outcome 2 Exacerbations.

Navigate to figure in ReviewOpen in new tab

Comparison 2 Stable state (> 6 months), Outcome 3 Sputum and biomarker characteristics.
Figures and Tables -
Analysis 2.3

Comparison 2 Stable state (> 6 months), Outcome 3 Sputum and biomarker characteristics.

Navigate to figure in ReviewOpen in new tab
Summary of findings for the main comparison. Inhaled corticosteroids compared to placebo for bronchiectasis (short‐term use of 6 months or less)

Inhaled corticosteroids compared to placebo for bronchiectasis (< 6 months)

Patient or population: people with bronchiectasis
Setting: university hospital
Intervention: inhaled corticosteroids
Comparison: placebo

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with placebo

Risk with Inhaled corticosteroids

Lung function (spirometry indices) ‐ FEV1 (in L, end study minus baseline values)

Mean change from baseline ranged from ‐0.038 to 0.805

MD 0.09 lower
(0.26 lower to 0.09 higher)

‐

156
(2 studies)

⊕⊕⊝⊝

Low1,2,3

Lung function (spirometry indices) ‐ FVC (in L, end study minus baseline values)

Mean change from baseline ranged from ‐0.062 to 0.0218

MD 0.01 higher
(0.16 lower to 0.17 higher)

‐

156
(2 studies)

⊕⊕⊝⊝

Low1,2,3

Lung function (other indices) ‐ diffusion capacity % predicted (end of study)

Mean end of study value 84.2

MD 2.70 higher
(2.49 lower to 7.89 higher)

‐

57
(1 study)

⊕⊕⊝⊝

Low1,2,3

Lung function (other indices) ‐ RV % predicted (end of study values)

Mean end of study value 106

MD 2.00 higher
(9.41 lower to 13.41 higher)

‐

57
(1 study)

⊕⊕⊝⊝

Low1,2,3

Lung function (other indices) ‐ TLC % predicted (end of study values)

Mean end of study value 86.4

MD 3.20 higher
(1.99 lower to 8.39 higher)

‐

57
(1 study)

⊕⊕⊝⊝

Low1,2,3

Average number of exacerbations per participant

Average number of exacerbations per patient ranged from 0.97 to 1.31

MD 0.17 lower
(0.56 lower to 0.22 higher)

‐

127
(2 studies)

⊕⊕⊝⊝

Low1,2,3

Pseudomonas aeruginosa (P aeruginosa) colonisation

410 per 1000

395 per 1000
(238 to 576)

OR 0.94
(0.45 to 1.96)

156
(2 studies)

⊕⊕⊝⊝

Low1,2,3

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; FEV1: forced expiratory volume in 1 second; FVC: forced vital capacity; MD: mean difference; OR: odds ratio; RV: residual volume; TLC: total lung capacity

GRADE Working Group grades of evidence
High‐certainty: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate‐certainty: we are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low‐certainty: our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low‐certainty: we have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1The largest study was not a placebo controlled trial (Martinez‐Garcia 2006).
2Study participant numbers are small; outcome downgraded one point for imprecision.
3One study had an issue with directness (Joshi 2004), but did not contribute to this outcome.

Figures and Tables -
Summary of findings for the main comparison. Inhaled corticosteroids compared to placebo for bronchiectasis (short‐term use of 6 months or less)
Navigate to table in Review
Summary of findings 2. Inhaled corticosteroids compared to placebo for bronchiectasis (longer‐term use of > 6 months)

Inhaled corticosteroids compared to placebo for bronchiectasis (medium‐ to long‐term outcomes)

Patient or population: people with bronchiectasis
Setting: university hospital
Intervention: inhaled corticosteroids
Comparison: placebo

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with placebo

Risk with Inhaled corticosteroids

Lung function indices ‐ FEV1% predicted (end study minus baseline values)

Mean change from baseline 0

MD 0.30 higher
(17.43 lower to 18.03 higher)

‐

86
(1 study)

⊕⊕⊝⊝

Low1,2

Lung function indices ‐ FVC % predicted (end study minus baseline values)

Mean change from baseline 0.9

MD 0.90 lower
(14.59 lower to 12.79 higher)

‐

86
(1 study)

⊕⊕⊝⊝

Low1,2

Number of participants improved

628 per 1000

490 per 1000
(288 to 693)

OR 0.57
(0.24 to 1.34)

86
(1 study)

⊕⊕⊝⊝

Low1,2

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: confidence interval; FEV1: forced expiratory volume in 1 second; FVC: forced vital capacity; MD: mean difference; OR: odds ratio

GRADE Working Group grades of evidence
High‐certainty: we are very confident that the true effect lies close to that of the estimate of the effect
Moderate‐certainty: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low‐certainty: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect
Very low‐certainty: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect

1Only a single study with small participant numbers; we downgraded outcome one point for imprecision.
2Single study with high/unclear risk of bias in several domains; we downgraded outcome one point for limitations.

Figures and Tables -
Summary of findings 2. Inhaled corticosteroids compared to placebo for bronchiectasis (longer‐term use of > 6 months)
Navigate to table in Review
Table 1. Summary of included studies characteristics

Study ID

Intervention

Control

Duration of intervention

Elborn 1992

Beclomethasone dipropionate 750 µg twice daily by MDI

Placebo

6 weeks

Hernando 2012

Budesonide 400 µg twice daily

Placebo

6 months

Joshi 2004

Beclomethasone 800 µg per day over 2 doses

Placebo

4 weeks

Martinez‐Garcia 2006

Fluticasone 500 µg twice daily by MDI or 250 µg fluticasone twice daily

No treatment

6 months

Tsang 1998

Fluticasone 500 µg twice daily by accuhaler

Placebo

4 weeks

Tsang 2004

Fluticasone 500 µg twice daily by accuhaler

Placebo

52 weeks

Tsang 2005

Fluticasone 500 µg twice daily by accuhaler

Placebo

52 weeks

MDI: metered dose inhaler
Figures and Tables -
Table 1. Summary of included studies characteristics
Navigate to table in Review
Comparison 1. Stable state bronchiectasis (6 months or less)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Lung function (spirometry indices) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

1.1 FEV1 (in L, end study minus baseline values)

2

156

Mean Difference (IV, Fixed, 95% CI)

‐0.09 [‐0.26, 0.09]

1.2 FVC (in L, end study minus baseline values)

2

156

Mean Difference (IV, Fixed, 95% CI)

0.01 [‐0.16, 0.17]

2 Lung function (other indices) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

2.1 Diffusion capacity % predicted (end of study)

1

57

Mean Difference (IV, Fixed, 95% CI)

2.70 [‐2.49, 7.89]

2.2 RV % predicted (end of study values)

1

57

Mean Difference (IV, Fixed, 95% CI)

2.0 [‐9.41, 13.41]

2.3 TLC % predicted (end of study values)

1

57

Mean Difference (IV, Fixed, 95% CI)

3.20 [‐1.99, 8.39]

3 Clinical severity indices Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

3.1 Number of participants with regular wheeze (combined)

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 Number of participants without sputum reduction of > 50% (combined)

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Number of participants with no improvement in dyspnoea score > 1 (min important difference) (1000F)

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.4 Number of participants with no clinically significant improvement in HRQoL

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Exacerbations Show forest plot

2

127

Mean Difference (IV, Fixed, 95% CI)

‐0.17 [‐0.56, 0.22]

4.1 Average number of exacerbations per participant

2

127

Mean Difference (IV, Fixed, 95% CI)

‐0.17 [‐0.56, 0.22]

5 Sputum and biomarkers characteristics Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

5.1 Sputum volume or weight (per day)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

6 Pseudomonas aeruginosa colonisation Show forest plot

2

156

Odds Ratio (M‐H, Fixed, 95% CI)

0.94 [0.45, 1.96]

7 St George HRQoL (end of study minus baseline) Show forest plot

2

Mean Difference (IV, Fixed, 95% CI)

Subtotals only

7.1 Total score

2

127

Mean Difference (IV, Fixed, 95% CI)

‐3.54 [‐8.00, 0.92]

7.2 Symptom score

2

127

Mean Difference (IV, Fixed, 95% CI)

‐4.75 [‐10.42, 0.92]

7.3 Activity score

2

127

Mean Difference (IV, Fixed, 95% CI)

‐6.21 [‐12.40, ‐0.01]

7.4 Impact score

1

70

Mean Difference (IV, Fixed, 95% CI)

‐3.63 [‐9.35, 2.09]
Figures and Tables -
Comparison 1. Stable state bronchiectasis (6 months or less)
Navigate to table in Review
Comparison 2. Stable state (> 6 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Lung function indices Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 FEV1% predicted (end study minus baseline values)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 FVC % predicted (end study minus baseline values)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Exacerbations Show forest plot

1

Odds Ratio (M‐H, Fixed, 95% CI)

Totals not selected

2.1 Number of participants improved

1

Odds Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Sputum and biomarker characteristics Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 Sputum purulence score

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]
Figures and Tables -
Comparison 2. Stable state (> 6 months)
Navigate to table in Review