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Reducción de la dosis de corticosteroides inhalados para pacientes adultos con asma

Appendices

Appendix 1. Sources and search methods for the Cochrane Airways Group Specialised Register

Electronic searches: core databases

Database

Frequency of search

CENTRAL (the Cochrane Library)

Monthly

MEDLINE (Ovid)

Weekly

Embase (Ovid)

Weekly

PsycINFO (Ovid)

Monthly

CINAHL (EBSCO)

Monthly

AMED (EBSCO)

Monthly

Handsearches: core respiratory conference abstracts

Conference

Years searched

American Academy of Allergy, Asthma and Immunology (AAAAI)

2001 onwards

American Thoracic Society (ATS)

2001 onwards

Asia Pacific Society of Respirology (APSR)

2004 onwards

British Thoracic Society Winter Meeting (BTS)

2000 onwards

Chest Meeting

2003 onwards

European Respiratory Society (ERS)

1992, 1994, 2000 onwards

International Primary Care Respiratory Group Congress (IPCRG)

2002 onwards

Thoracic Society of Australia and New Zealand (TSANZ)

1999 onwards

MEDLINE search strategy used to identify trials for the Cochrane Airways Group Specialised Register

Asthma search

1. exp Asthma/

2. asthma$.mp.

3. (antiasthma$ or anti‐asthma$).mp.

4. Respiratory Sounds/

5. wheez$.mp.

6. Bronchial Spasm/

7. bronchospas$.mp.

8. (bronch$ adj3 spasm$).mp.

9. bronchoconstrict$.mp.

10. exp Bronchoconstriction/

11. (bronch$ adj3 constrict$).mp.

12. Bronchial Hyperreactivity/

13. Respiratory Hypersensitivity/

14. ((bronchial$ or respiratory or airway$ or lung$) adj3 (hypersensitiv$ or hyperreactiv$ or allerg$ or insufficiency)).mp.

15. ((dust or mite$) adj3 (allerg$ or hypersensitiv$)).mp.

16. or/1‐15

Filter to identify RCTs

1. exp "clinical trial [publication type]"/

2. (randomised or randomised).ab,ti.

3. placebo.ab,ti.

4. dt.fs.

5. randomly.ab,ti.

6. trial.ab,ti.

7. groups.ab,ti.

8. or/1‐7

9. Animals/

10. Humans/

11. 9 not (9 and 10)

12. 8 not 11

The MEDLINE strategy and the RCT filter are adapted to identify trials in other electronic databases.

Appendix 2. Search strategy to identify relevant trials from the Cochrane Airways Group Specialised Register

#1 AST:MISC1

#2 MeSH DESCRIPTOR Asthma Explode All

#3 asthma*:ti,ab

#4 #1 or #2 or #3

#5 MeSH DESCRIPTOR Adrenal Cortex Hormones Explode All

#6 (steroid* or corticosteroid* or glucocorticosteroid* or glucocorticoid* or corticoid*) AND (inhal*)

#7 ICS:ti,ab,kw

#8 beclomethasone or beclometasone

#9 budesonide

#10 fluticasone

#11 ciclesonide

#12 mometasone

#13 flunisolide

#14 triamcinolone

#15 #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14

#16 step* NEAR3 down*

#17 (reduc* or decreas*) NEAR3 (dose* or treatment* or therap*)

#18 down* NEAR3 titrat*

#19 MeSH DESCRIPTOR Drug Administration Schedule Explode All

#20 #16 or #17 or #18 or #19

#21 #4 AND #15 AND #20

[Note: in search line #1, MISC1 denotes the field in which the reference has been coded for condition, in this case, asthma.]

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

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

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 3

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

Forest plot of comparison: 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), outcome: 1.1 Exacerbation requiring OCS.
Figures and Tables -
Figure 4

Forest plot of comparison: 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), outcome: 1.1 Exacerbation requiring OCS.

Forest plot of comparison: 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), outcome: 2.1 Exacerbation requiring OCS.
Figures and Tables -
Figure 5

Forest plot of comparison: 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), outcome: 2.1 Exacerbation requiring OCS.

Forest plot of comparison: 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), outcome: 1.3 All‐cause SAEs.
Figures and Tables -
Figure 6

Forest plot of comparison: 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), outcome: 1.3 All‐cause SAEs.

Forest plot of comparison: 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), outcome: 2.4 All‐cause SAEs.
Figures and Tables -
Figure 7

Forest plot of comparison: 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), outcome: 2.4 All‐cause SAEs.

Forest plot of comparison: 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), outcome: 1.4 Steroid‐related AEs.
Figures and Tables -
Figure 8

Forest plot of comparison: 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), outcome: 1.4 Steroid‐related AEs.

Forest plot of comparison: 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), outcome: 1.7 Lung function, FEV1 (L).
Figures and Tables -
Figure 9

Forest plot of comparison: 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), outcome: 1.7 Lung function, FEV1 (L).

Forest plot of comparison: 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), outcome: 1.6 Lung function, PEFR morning (L/min).
Figures and Tables -
Figure 10

Forest plot of comparison: 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), outcome: 1.6 Lung function, PEFR morning (L/min).

Forest plot of comparison: 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), outcome: 2.9 Exacerbation requiring hospitalisation.
Figures and Tables -
Figure 11

Forest plot of comparison: 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), outcome: 2.9 Exacerbation requiring hospitalisation.

Comparison 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), Outcome 1 Exacerbation requiring OCS.
Figures and Tables -
Analysis 1.1

Comparison 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), Outcome 1 Exacerbation requiring OCS.

Comparison 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), Outcome 2 Asthma control.
Figures and Tables -
Analysis 1.2

Comparison 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), Outcome 2 Asthma control.

Comparison 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), Outcome 3 All‐cause SAEs.
Figures and Tables -
Analysis 1.3

Comparison 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), Outcome 3 All‐cause SAEs.

Comparison 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), Outcome 4 Steroid‐related AEs.
Figures and Tables -
Analysis 1.4

Comparison 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), Outcome 4 Steroid‐related AEs.

Comparison 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), Outcome 5 Juniper AQLQ score (change from baseline).
Figures and Tables -
Analysis 1.5

Comparison 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), Outcome 5 Juniper AQLQ score (change from baseline).

Comparison 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), Outcome 6 Lung function, PEFR morning (L/min).
Figures and Tables -
Analysis 1.6

Comparison 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), Outcome 6 Lung function, PEFR morning (L/min).

Comparison 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), Outcome 7 Lung function, FEV1 (L).
Figures and Tables -
Analysis 1.7

Comparison 1 ICS dose reduction versus no change in ICS dose (no concomitant LABA), Outcome 7 Lung function, FEV1 (L).

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 1 Exacerbation requiring OCS.
Figures and Tables -
Analysis 2.1

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 1 Exacerbation requiring OCS.

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 2 Asthma control (short asthma morbidity score), change from baseline.
Figures and Tables -
Analysis 2.2

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 2 Asthma control (short asthma morbidity score), change from baseline.

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 3 Asthma control (Asthma Severity Questionnaire).
Figures and Tables -
Analysis 2.3

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 3 Asthma control (Asthma Severity Questionnaire).

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 4 All‐cause SAEs.
Figures and Tables -
Analysis 2.4

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 4 All‐cause SAEs.

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 5 EuroQoL score (change from baseline).
Figures and Tables -
Analysis 2.5

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 5 EuroQoL score (change from baseline).

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 6 St. George's Respiratory Scale score (change from baseline).
Figures and Tables -
Analysis 2.6

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 6 St. George's Respiratory Scale score (change from baseline).

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 7 Lung function, PEFR morning (L/min) (change from baseline).
Figures and Tables -
Analysis 2.7

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 7 Lung function, PEFR morning (L/min) (change from baseline).

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 8 Lung function, reduction in FEV1 (% predicted, change from baseline).
Figures and Tables -
Analysis 2.8

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 8 Lung function, reduction in FEV1 (% predicted, change from baseline).

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 9 Exacerbation requiring hospitalisation.
Figures and Tables -
Analysis 2.9

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 9 Exacerbation requiring hospitalisation.

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 10 Exacerbation requiring ED visit.
Figures and Tables -
Analysis 2.10

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 10 Exacerbation requiring ED visit.

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 11 Mortality.
Figures and Tables -
Analysis 2.11

Comparison 2 ICS dose reduction versus no change in ICS dose (concomitant LABA), Outcome 11 Mortality.

Summary of findings for the main comparison. ICS dose reduction compared with no change in ICS dose (no concomitant LABA) for adults with asthma

ICS dose reduction compared with no change in ICS dose (no concomitant LABA) for adults with asthma

Patient or population: adults with asthma
Setting: primary care and specialist centres
Intervention: ICS dose reduction
Comparison: no change in ICS dose (no concomitant LABA)

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with no change in ICS dose (no concomitant LABA)

Risk with ICS dose reduction

Exacerbation requiring OCS
Follow‐up: range 10 weeks to 12 weeks

8 per 1000

14 per 1000
(1 to 140)

OR 1.86
(0.16 to 21.09)

261
(2 RCTs)

⊕⊝⊝⊝
Very lowa

No clear benefit or harm of stepping down the dose of ICS (very low‐quality evidence)

Asthma control
assessed by: Asthma Symptom Scale from: 0 (no symptoms) to 5 (severe symptoms)
Follow‐up: 10 weeks

Mean asthma control score in the no change in ICS dose group was 1.79.

MD 0.22 lower
(1.05 lower to 0.61 higher)

150
(1 RCT)

⊕⊕⊝⊝
Lowb

No clear benefit or harm of stepping down the dose of ICS (low‐quality evidence)

All‐cause SAEs
Follow‐up: mean 12 weeks

8 per 1000

9 per 1000
(2 to 45)

OR 1.24
(0.25 to 6.25)

742
(2 RCTs)

⊕⊕⊝⊝
Lowc

No clear benefit or harm of stepping down the dose of ICS (low‐quality evidence)

Steroid‐related AEs
Follow‐up: range 10 weeks to 12 weeks

31 per 1000

23 per 1000
(5 to 100)

OR 0.76
(0.16 to 3.54)

261
(2 RCTs)

⊕⊝⊝⊝
Very lowd

No clear benefit or harm of stepping down the dose of ICS (very low‐quality evidence)

Health‐related quality of life (change from baseline)
assessed by: AQLQ
Follow‐up: 12 weeks

Mean change from baseline in health‐related quality of life for the no change in ICS dose group was 0.02.

MD 0.21 lower
(0.33 lower to 0.09 lower)

554
(1 RCT)

⊕⊝⊝⊝
Very lowe

No clear benefit or harm of stepping down the dose of ICS (very low‐quality evidence); MCID is 0.5 for AQLQ

Lung function, FEV1 (L)
assessed by: spirometry
Follow‐up: range 10 weeks to 12 weeks

Mean FEV1 in the no change in ICS dose group was 3.15 litres.

MD 0.02 litres lower
(0.12 lower to 0.08 higher)

261
(2 RCTs)

⊕⊕⊝⊝
Lowf

No clear benefit or harm of stepping down the dose of ICS (low‐quality evidence)

Exacerbations requiring hospitalisation ‐ not reported

Outcome not reported by included studies

*Risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
aThe quality of the evidence was downgraded once for indirectness (included studies were performed at specialist centres) and twice for imprecision (no events reported by Magnussen 2000; confidence intervals include null effect and appreciable benefit or harm).

bThe quality of the evidence was downgraded once for risk of bias (selective reporting) and once for indirectness (single study representative of one setting and drug regimen).

cThe quality of the evidence was downgraded once for risk of bias (selective reporting) and once for imprecision (confidence intervals include null effect and appreciable benefit or harm).

dThe quality of the evidence was downgraded once for risk of bias (selective reporting), once for indirectness (representative of specialist centres) and once for imprecision (confidence intervals include null effect and appreciable benefit or harm).

eThe quality of the evidence was downgraded twice for risk of bias (selective reporting and lack of blinding (subjective outcome)) and once for indirectness (single study representative of one setting and drug regimen).

fThe quality of the evidence was downgraded once for risk of bias (selective reporting) and once for imprecision (confidence intervals include null effect and appreciable benefit or harm).
AE, adverse event; AQLQ, Asthma Quality of Life Questionnaire; CI, confidence interval; FEV1, forced expiratory volume in one second; GRADE, Grades of Recommendation, Assessment, Development and Evaluation; ICS, inhaled corticosteroid; LABA, long‐acting beta agonist; MCID, minimum clinically important difference; MD, mean difference; OCS, oral corticosteroid; OR, odds ratio; RCT, randomised controlled trial; RR, risk ratio; SAE, serious adverse event.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to the estimate of effect.
Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of effect but may be substantially different.
Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of effect.
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.

Figures and Tables -
Summary of findings for the main comparison. ICS dose reduction compared with no change in ICS dose (no concomitant LABA) for adults with asthma
Summary of findings 2. ICS dose reduction compared with no change in ICS dose (concomitant LABA) for adults with asthma

ICS dose reduction compared with no change in ICS dose (concomitant LABA) for adults with asthma

Patient or population: adults with asthma
Setting: primary and secondary care
Intervention: ICS dose reduction
Comparison: no change in ICS dose (concomitant LABA)

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Risk with no change in ICS dose (concomitant LABA)

Risk with ICS dose reduction

Exacerbation requiring OCS
Follow‐up: range 4 months to 12 months

148 per 1000

186 per 1000
(125 to 266)

OR 1.31
(0.82 to 2.08)

569
(2 RCTs)

⊕⊕⊝⊝
Lowa

No clear benefit or harm of stepping down the dose of ICS with respect to exacerbations requiring OCS (low‐quality evidence)

Asthma control (short asthma morbidity score)
Follow‐up: 12 months

Mean asthma control score was 1.43.

MD 0.16 higher
(0.34 lower to 0.66 higher)

242
(1 RCT)

⊕⊕⊝⊝
Lowb

No clear benefit or harm of stepping down the dose of ICS with respect to asthma control (low‐quality evidence)

All‐cause SAEs
Follow‐up: range 4 months to 12 months

35 per 1000

22 per 1000
(4 to 109)

OR 0.60
(0.11 to 3.33)

569
(2 RCTs)

⊕⊕⊝⊝
Lowa

No clear benefit or harm of stepping down the dose of ICS with respect to all‐cause SAEs (low‐quality evidence)

Steroid‐related AEs ‐ not reported

St. George's Respiratory Scale score (change from baseline)
Follow‐up: 12 months

Score 0‐100. 100 = greatest impact of chest disease on life; MCID is 4 units.

Mean change from baseline in HRQoL score was 7.4.c

MD 0.13 higher
(2.8 lower to 3.06 higher)

229
(1 RCT)

⊕⊕⊝⊝
Lowb

No clear benefit or harm of stepping down the dose of ICS with respect to HRQoL (low‐quality evidence)

Exacerbation requiring hospitalisation
Follow‐up: range 4 months to 12 months

4 per 1000

14 per 1000
(2 to 116)

OR 4.06
(0.45 to 36.86)

569
(2 RCTs)

⊕⊕⊝⊝
Lowd

No clear benefit or harm of stepping down the dose of ICS with respect to exacerbations requiring hospitalisation (low‐quality evidence)

Lung function, reduction in FEV1 (% predicted, change from baseline)
Follow‐up: 3 months

Mean change from baseline in % predicted FEV1 was ‐0.75%.

MD 2.45 lower
(8.88 lower to 3.98 higher)

14
(1 RCT)

⊕⊝⊝⊝
Very lowe

No clear benefit or harm of stepping down the dose of ICS with respect to lung function (very low‐quality evidence)

*Risk in the intervention group (and its 95% confidence interval) is based on assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
aThe quality of the evidence was downgraded once for risk of bias (selective reporting) and once for imprecision (confidence intervals include null effect and appreciable benefit or harm).

bThe quality of the evidence was downgraded once for risk of bias (selective reporting) and once for indirectness (single study representative of one setting and drug regimen).

cNote that study authors reported the change to the lowest SGRQ score during follow‐up.

dThe quality of the evidence was downgraded once for risk of bias (selective reporting) and once for imprecision (confidence intervals include null effect and appreciable benefit or harm).

eThe quality of the evidence was downgraded once for risk of bias (selective reporting), once for indirectness (single study representative of one setting or drug regimen) and once for imprecision (wide CI).

AE, adverse event; CI, confidence interval; FEV1, forced expiratory volume in one second; GRADE, Grades of Recommendation, Assessment, Development and Evaluation; HRQoL, health‐related quality of life; ICS, inhaled corticosteroid; LABA, long‐acting beta agonist; MCID, minimum clinically important difference; MD, mean difference; OCS, oral corticosteroid; OR, odds ratio; RCT, randomised controlled trial; RR, risk ratio; SAE, serious adverse event.

GRADE Working Group grades of evidence
High quality: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate quality: 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 quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

Figures and Tables -
Summary of findings 2. ICS dose reduction compared with no change in ICS dose (concomitant LABA) for adults with asthma
Comparison 1. ICS dose reduction versus no change in ICS dose (no concomitant LABA)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Exacerbation requiring OCS Show forest plot

2

261

Odds Ratio (M‐H, Random, 95% CI)

1.86 [0.16, 21.09]

2 Asthma control Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

3 All‐cause SAEs Show forest plot

2

742

Odds Ratio (M‐H, Random, 95% CI)

1.24 [0.25, 6.25]

4 Steroid‐related AEs Show forest plot

2

261

Odds Ratio (M‐H, Random, 95% CI)

0.76 [0.16, 3.54]

5 Juniper AQLQ score (change from baseline) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

6 Lung function, PEFR morning (L/min) Show forest plot

3

875

Mean Difference (IV, Random, 95% CI)

‐5.98 [‐19.47, 7.51]

7 Lung function, FEV1 (L) Show forest plot

2

261

Mean Difference (IV, Random, 95% CI)

‐0.02 [‐0.12, 0.08]

Figures and Tables -
Comparison 1. ICS dose reduction versus no change in ICS dose (no concomitant LABA)
Comparison 2. ICS dose reduction versus no change in ICS dose (concomitant LABA)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Exacerbation requiring OCS Show forest plot

2

569

Odds Ratio (M‐H, Random, 95% CI)

1.31 [0.82, 2.08]

2 Asthma control (short asthma morbidity score), change from baseline Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

3 Asthma control (Asthma Severity Questionnaire) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

4 All‐cause SAEs Show forest plot

2

569

Odds Ratio (M‐H, Random, 95% CI)

0.60 [0.11, 3.33]

5 EuroQoL score (change from baseline) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

6 St. George's Respiratory Scale score (change from baseline) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

7 Lung function, PEFR morning (L/min) (change from baseline) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

8 Lung function, reduction in FEV1 (% predicted, change from baseline) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

9 Exacerbation requiring hospitalisation Show forest plot

2

569

Odds Ratio (M‐H, Random, 95% CI)

4.06 [0.45, 36.86]

10 Exacerbation requiring ED visit Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

11 Mortality Show forest plot

1

310

Odds Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figures and Tables -
Comparison 2. ICS dose reduction versus no change in ICS dose (concomitant LABA)