Findings

What do systematic reviews say?

539 questions · 553 findings · 58 reviews · Airways

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No studies found 37 · 6.7%GRADE not reported 8 · 1.4%Very low 27 · 4.9%Low 161 · 29.1%Moderate 219 · 39.6%High 101 · 18.3%

Intermittent ICS vs placebo

Serious adverse events · School‐aged children and adults

Intermittent ICS showed no clear difference in serious adverse events compared with placebo (moderate certainty).

1 finding from 1 review

Intermittent inhaled corticosteroid therapy versus placebo for persistent asthma in children and adults 2015 · Cochrane Headline outcomes only
OR 1 [0.14, 7.25]
2 studies · 385 participants
Moderate

Intermittent ICS vs placebo

Day time asthma score Mean difference · School‐aged children and adults

1 finding from 1 review

Intermittent inhaled corticosteroid therapy versus placebo for persistent asthma in children and adults 2015 · Cochrane Headline outcomes only
no estimate extracted
1 study · 240 participants
Moderate

Intermittent ICS vs placebo

Night time asthma score Mean difference · School‐aged children and adults

1 finding from 1 review

Intermittent inhaled corticosteroid therapy versus placebo for persistent asthma in children and adults 2015 · Cochrane Headline outcomes only
no estimate extracted
1 study · 240 participants
Moderate

Intermittent ICS vs placebo

Adverse events · School‐aged children and adults

Intermittent ICS showed no clear difference in adverse events compared with placebo (low certainty).

1 finding from 1 review

Intermittent inhaled corticosteroid therapy versus placebo for persistent asthma in children and adults 2015 · Cochrane Headline outcomes only
OR 2.9 [0.12, 71.96]
1 study · 243 participants
Low

Intermittent ICS vs placebo

Mean exacerbations requiring a course of oral corticosteroids · Preschool children (<6 years)

Intermittent ICS probably leads to lower exacerbations requiring oral corticosteroids compared with placebo (moderate certainty).

1 finding from 1 review

Intermittent inhaled corticosteroid therapy versus placebo for persistent asthma in children and adults 2015 · Cochrane Headline outcomes only
OR 0.48 [0.31, 0.73]
4 studies · 490 participants
Moderate

Intermittent ICS vs placebo

Serious adverse events · Preschool children (<6 years)

Intermittent ICS showed no clear difference in serious adverse events compared with placebo (low certainty).

1 finding from 1 review

Intermittent inhaled corticosteroid therapy versus placebo for persistent asthma in children and adults 2015 · Cochrane Headline outcomes only
OR 0.42 [0.17, 1.02]
3 studies · 439 participants
Low

Intermittent ICS vs placebo

Hospital admissions · Preschool children (<6 years)

It is very uncertain whether intermittent ICS changes hospitalisations compared with placebo (very low certainty).

1 finding from 1 review

Intermittent inhaled corticosteroid therapy versus placebo for persistent asthma in children and adults 2015 · Cochrane Headline outcomes only
OR 0.73 [0.23, 2.29]
3 studies · 327 participants
Very low

Tiotropium vs placebo

QoL · people with COPD who have smoked for ≥ 10 pack‐years

Tiotropium showed no clear difference in quality of life (SGRQ) Scale 0 to 100, where 100 represents worst… compared with placebo (high certainty).

1 finding from 1 review

Tiotropium versus placebo for chronic obstructive pulmonary disease 2014 · Cochrane Headline outcomes only
no estimate extracted
9 studies · 13034 participants
High

Tiotropium vs placebo

Quality of life: number of participants with clinically significant improvement (≥ 4 units) in SGRQ total score · people with COPD who have smoked for ≥ 10 pack‐years

Tiotropium leads to higher number of patients with a clinically significant improvement (≥ 4… compared with placebo (high certainty).

1 finding from 1 review

Tiotropium versus placebo for chronic obstructive pulmonary disease 2014 · Cochrane Headline outcomes only
OR 1.52 [1.38, 1.68]
9 studies · 11672 participants
High

Tiotropium vs placebo

Number of patients with a clinically significant worsening (≥ 4 units) in quality of life (SGRQ) · people with COPD who have smoked for ≥ 10 pack‐years

Tiotropium leads to lower number of patients with a clinically significant worsening (≥ 4… compared with placebo (high certainty).

1 finding from 1 review

Tiotropium versus placebo for chronic obstructive pulmonary disease 2014 · Cochrane Headline outcomes only
OR 0.65 [0.59, 0.72]
9 studies · 11672 participants
High

Tiotropium vs placebo

Exacerbations (number of people experiencing ≥ 1 exacerbations) · people with COPD who have smoked for ≥ 10 pack‐years

Tiotropium leads to lower number of patients with one or more exacerbations compared with placebo (high certainty).

1 finding from 1 review

Tiotropium versus placebo for chronic obstructive pulmonary disease 2014 · Cochrane Headline outcomes only
OR 0.78 [0.7, 0.87]
22 studies · 23309 participants
High

Tiotropium vs placebo

Hospital admissions due to exacerbations: number of participants · people with COPD who have smoked for ≥ 10 pack‐years

Tiotropium showed no clear difference in number of patients with one or more exacerbations requiring… compared with placebo (moderate certainty).

1 finding from 1 review

Tiotropium versus placebo for chronic obstructive pulmonary disease 2014 · Cochrane Headline outcomes only
OR 0.85 [0.72, 1]
21 studies · 22852 participants
Moderate

Tiotropium vs placebo

Hospital admissions · people with COPD who have smoked for ≥ 10 pack‐years

Tiotropium showed no clear difference in number of patients with one or more hospitalisations for any cause compared with placebo (moderate certainty).

1 finding from 1 review

Tiotropium versus placebo for chronic obstructive pulmonary disease 2014 · Cochrane Headline outcomes only
OR 1 [0.88, 1.13]
19 studies · 20963 participants
Moderate

Tiotropium vs placebo

All‐cause mortality · people with COPD who have smoked for ≥ 10 pack‐years

Tiotropium showed no clear difference in mortality compared with placebo (moderate certainty).

1 finding from 1 review

Tiotropium versus placebo for chronic obstructive pulmonary disease 2014 · Cochrane Headline outcomes only
OR 0.98 [0.86, 1.11]
22 studies · 23309 participants
Moderate

Combined inhalers vs placebo (outcomes

Annual Exacerbation Rates · COPD

Combined inhalers probably leads to lower annual exacerbation rates compared with placebo (primary outcomes) (moderate certainty).

1 finding from 1 review

Combined corticosteroid and long‐acting beta₂‐agonist in one inhaler versus placebo for chronic obstructive pulmonary… 2013 · Cochrane Headline outcomes only
Rate ratio 0.73 [0.69, 0.78]
7473 participants
Moderate

Budesonide/formoterol (BDF) vs placebo

Adverse events—'serious'—320/94 Duration of 10 months3 · COPD

Budesonide/formoterol (BDF) showed no clear difference in adverse events—'serious'—320/94 Duration of 10 months3 compared with placebo (low certainty).

1 finding from 1 review

Combined corticosteroid and long‐acting beta₂‐agonist in one inhaler versus placebo for chronic obstructive pulmonary… 2013 · Cochrane Headline outcomes only
OR 1.17 [0.95, 1.45]
2476 participants
Low

Budesonide/formoterol (BDF) vs placebo

Adverse events—'serious'—160/94 Duration of nine months 3 · COPD

Budesonide/formoterol (BDF) showed no clear difference in adverse events—'serious'—160/94 Duration of nine months 3 compared with placebo (low certainty).

1 finding from 1 review

Combined corticosteroid and long‐acting beta₂‐agonist in one inhaler versus placebo for chronic obstructive pulmonary… 2013 · Cochrane Headline outcomes only
OR 1.2 [0.89, 1.63]
1556 participants
Low

Mometasone/formoterol (MF/F) vs placebo

Adverse events at study endpoint · patients with chronic obstructive pulmonary disease

Mometasone/formoterol (MF/F) showed no clear difference in adverse event—any—400/103 Duration of six months compared with placebo (low certainty).

2 findings from 1 review

Combined corticosteroid and long‐acting beta₂‐agonist in one inhaler versus placebo for chronic obstructive pulmonary… 2013 · Cochrane Headline outcomes only
OR 0.98 [0.75, 1.3]
890 participants
Low
Combined corticosteroid and long‐acting beta₂‐agonist in one inhaler versus placebo for chronic obstructive pulmonary… 2013 · Cochrane Headline outcomes only
OR 0.82 [0.62, 1.09]
894 participants
Low

Mometasone/formoterol (MF/F) vs placebo

Adverse events—serious—400/103 Duration of six months · patients with chronic obstructive pulmonary disease

Mometasone/formoterol (MF/F) showed no clear difference in adverse events—serious—400/103 Duration of six months compared with placebo (low certainty).

1 finding from 1 review

Combined corticosteroid and long‐acting beta₂‐agonist in one inhaler versus placebo for chronic obstructive pulmonary… 2013 · Cochrane Headline outcomes only
OR 1.09 [0.66, 1.79]
890 participants
Low

Mometasone/formoterol (MF/F) vs placebo

Adverse events—serious—200/103 Duration of six months · patients with chronic obstructive pulmonary disease

Mometasone/formoterol (MF/F) showed no clear difference in adverse events—serious—200/103 Duration of six months compared with placebo (low certainty).

1 finding from 1 review

Combined corticosteroid and long‐acting beta₂‐agonist in one inhaler versus placebo for chronic obstructive pulmonary… 2013 · Cochrane Headline outcomes only
OR 0.71 [0.41, 1.23]
894 participants
Low