Findings

What do systematic reviews say?

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Evidence found and GRADE certainty

51 questions · 53 findings · 27 reviews · Airways

No studies found 5 · 9.4%GRADE not reported 1 · 1.9%Very low 4 · 7.5%Low 18 · 34%Moderate 21 · 39.6%High 4 · 7.5%

Self‐management interventions vs usual care

Courses of oral corticosteroids · patients with chronic obstructive pulmonary disease

Self‐management interventions including action plans for exacerbations showed no clear difference in courses of oral steroids compared with usual care (low certainty).

1 finding from 1 review

Maintenance LTRA vs placebo

Number of participants experiencing one or more episode requiring treatment with oral steroids · episodic viral wheeze in children

Maintenance LTRA showed no clear difference in number of participants experiencing one or more episode requiring… compared with placebo (moderate certainty).

1 finding from 1 review

Intermittent LTRA vs placebo

Number of participants experiencing one or more episode requiring treatment with oral steroids · episodic viral wheeze in children

Intermittent LTRA showed no clear difference in number of participants experiencing one or more episode requiring… compared with placebo (moderate certainty).

1 finding from 1 review

MHRV vs placebo

Mean exacerbations requiring a course of oral corticosteroids · asthmatics with sensitivity to house dust mite

MHRV showed no clear difference in exacerbations needing oral steroids compared with placebo (moderate certainty).

1 finding from 1 review

160/4.5 mcg BDF single inhaler therapy vs current best practice

Rate of exacerbations requiring systemic corticosteroids · adults with asthma not well controlled on ICS

160/4.5 mcg BDF single inhaler therapy probably leads to lower patients with exacerbations treated with oral steroids compared with current best practice (moderate certainty).

1 finding from 1 review

Single inhaler therapy vs fixed dose ICS

Rate of exacerbations requiring systemic corticosteroids · adults with asthma not well controlled on ICS

Single inhaler therapy leads to lower patients with exacerbations treated with oral steroids compared with fixed dose ICS (high certainty).

1 finding from 1 review

SiT for maintenance/relief vs higher‐dose ICS/LABA + SABA

Exacerbations requiring oral corticosteroids ‐ adults · Studies recruited adults and adolescents aged 12 and older with chronic asthma

SiT for maintenance/relief leads to lower patients with exacerbations requiring oral steroids compared with higher‐dose ICS/LABA + SABA (high certainty).

1 finding from 1 review

Long‐acting beta2‐agonists vs placebo

Moderate exacerbations (course of antibiotics or oral steroids) · patients with chronic obstructive pulmonary disease

Long‐acting beta2‐agonists probably leads to lower moderate exacerbations (course of antibiotics or oral steroids) compared with placebo (moderate certainty).

1 finding from 1 review

Intramuscular corticosteroids vs oral corticosteroid

Relapse · patients with acute asthma

Intramuscular corticosteroids showed no clear difference in relapse compared with oral corticosteroids (low certainty).

3 findings from 1 review

Once‐daily ICS/LABA combined inhalers vs once‐daily LAMA

Any COPD exacerbation that requires short‐burst oral corticosteroids or antibiotics, or both · patients with chronic obstructive pulmonary disease

It is very uncertain whether once‐daily ICS/LABA combined inhalers changes any COPD exacerbation that requires short‐burst oral corticosteroids… compared with once‐daily LAMA (very low certainty).

1 finding from 1 review

Intervention not reported

Patients with ≥ 1 exacerbations requiring oral corticosteroids Duration of trials: 6 to 16 weeks · adults and adolescents with persistent asthma

The intervention probably leads to lower patients with ≥ 1 exacerbations requiring oral corticosteroids… (moderate certainty).

1 finding from 1 review

Intervention not reported

Participants with ≥ 1 exacerbation requiring oral corticosteroids Duration of trials: 8 to 24 weeks · adults and adolescents with persistent asthma

The intervention showed no clear difference in participants with ≥ 1 exacerbation requiring oral corticosteroids… (low certainty).

1 finding from 1 review

Intervention not reported

Patients with ≥ 1 exacerbation requiring oral corticosteroids Duration of trials: 8 to 13 weeks · adults and adolescents with persistent asthma

The intervention showed no clear difference in patients with ≥ 1 exacerbation requiring oral corticosteroids… (moderate certainty).

1 finding from 1 review