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Cochrane Database of Systematic Reviews

Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children

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Información

DOI:
https://doi.org/10.1002/14651858.CD007524.pub3Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 08 diciembre 2010see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:
  1. Grupo Cochrane de Vías respiratorias

Copyright:
  1. Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Bradley S Quon

    Medicine, University of British Columbia, Vancouver, Canada

  • J. Mark FitzGerald

    Vancouver General Hospital, Vancouver, Canada

  • Catherine Lemière

    Chest Department, Hôpital du Sacré‐Coeur de Montréal, Montreal, Canada

  • Neal Shahidi

    Division of Respirology, University of British Columbia, Vancouver, Canada

  • Francine M Ducharme

    Correspondencia a: Research Centre, CHU Sainte‐Justine and the Department of Pediatrics, University of Montreal, Montreal, Canada

    [email protected]

Contributions of authors

BQ: Protocol initiation and write‐up; study assessment, characterisation and data extraction; write‐up

MF: Protocol development

NS: Study assessment, characterisation and data extraction

Toby Lasserson: Protocol development (elected to stand down from the review)

FD: Protocol development; interpretation of data, write‐up and editorial sign‐off

CL: Protocol development; write‐up

Declarations of interest

Francine Ducharme has received grant support for investigator‐initiated studies from Merck and Co and GlaxoSmithKline. Mark Fitzgerald has carried out a number of clinical research projects funded by industry related to optimal asthma management including one specifically addressing the issue under review. He has also worked as a consultant for a number of companies presenting at CME events and also in an advisory capacity regarding clinical research programmes. Catherine Lemière has received grant support for investigator‐initiated study from Merck‐Frosst and GlaxoSmithKline. She has worked as a consultant for a number of companies (Topigen and GlaxoSmithKline). She has been a member of advisory boards for AstraZeneca, Altana and GlaxoSmithKline. Toby Lasserson (protocol only), Bradley Quon and Neal Shahidi report no conflicts of interest.

Acknowledgements

We thank the Cochrane Airways Review Group, namely Liz Arnold for the literature search and ongoing support. We appreciate the co‐operation of corresponding authors: Tim Harrison and Janet Oborne who kindly responded to our request for information.

Version history

Published

Title

Stage

Authors

Version

2022 Sep 26

Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children

Review

Kayleigh M Kew, Ella Flemyng, Bradley S Quon, Clarus Leung

https://doi.org/10.1002/14651858.CD007524.pub5

2016 Jun 07

Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children

Review

Kayleigh M Kew, Michael Quinn, Bradley S Quon, Francine M Ducharme

https://doi.org/10.1002/14651858.CD007524.pub4

2010 Dec 08

Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children

Review

Bradley S Quon, J. Mark FitzGerald, Catherine Lemière, Neal Shahidi, Francine M Ducharme

https://doi.org/10.1002/14651858.CD007524.pub3

2010 Oct 06

Increased versus stable doses of inhaled corticosteroids for exacerbations of chronic asthma in adults and children

Review

Bradley S Quon, J. Mark FitzGerald, Catherine Lemière, Neal Shahidi, Francine M Ducharme

https://doi.org/10.1002/14651858.CD007524.pub2

2009 Jan 21

Increased versus stable doses of inhaled steroids for exacerbations of chronic asthma in adults and children

Protocol

Bradley Quon, J. Mark FitzGerald, Francine M Ducharme, Toby J Lasserson, Catherine Lemière

https://doi.org/10.1002/14651858.CD007524

Differences between protocol and review

The data synthesis section of our protocol initially read as follows "we will report fixed‐effect rate ratios, such as the rate of the need for rescue systemic corticosteroids per person‐years of follow up in treatment and control groups". There were two changes made to this statement. The fixed‐effect model was used if there was no significant heterogeneity, otherwise the random‐effects model was used. As we could not obtain individual patient level data, event rates could not be calculated and therefore we defaulted to comparing frequency of events (number of patients requiring rescue systemic corticosteroids in treatment and control groups).

We did not discuss unit of analysis issues for parallel and cross‐over studies in the protocol. We did not pool parallel and cross‐over study results. For dichotomous outcomes, studies were pooled using M‐H odds ratios unless there was a low number of events reported requiring Peto odds ratios. Marginal odds ratio was obtained from the cross‐over trial by comparing the number of patients who needed OCS on increased dose (but not on placebo) with those who needed OCS on placebo (but not on double dose ICS).

For the primary outcome (Analysis 1.1), the denominator was changed from number of patients requiring the study inhaler to the number of patients randomised, consistent with ITT analysis. As a secondary outcome (Analysis 1.9), treatment failure was re‐analysed based on the number of patients requiring the study inhaler.

Magnitude of ICS dose increase (two‐fold versus four‐fold) was added as a subgroup analysis (Analysis 1.7). Post‐hoc subgroup analyses were also performed on the modified ITT analysis of the primary outcome (Analysis 1.10 to Analysis 1.15).

An additional review author, NS, was added to assist with selection of studies, data extraction and management and assessment of risk of bias in included studies.

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.