Grade table 12

Question: Should ipratropium bromide versus short-acting beta2 agonist be used in patients with COPD?

Settings: LMICs

Bibliography: Appleton S et al. (23)

Quality assessmentSummary of findingsImportance
No of patientsEffectsQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsIpratropium bromideShort-acting beta2 agonistRelative (95% CI)Absolute
Mortality (assessed with: number of people died)
7randomised trials1none–––––IMPORTANT
-0%–
HRQoL using CRQ dyspnoea domain (follow-up 84-90 days; measured with: absolute scores; better indicated by higher values)
5randomised trialsno serious limitationsserious2serious3serious4reporting bias5774755–MD 0.16 higher (0.09 to 0.23 higher)⊕○○○
VERY LOW		IMPORTANT
HRQoL using CRQ fatigue domain (follow-up 84–90 days; measured with: absolute scores; better indicated by higher values)
5randomised trialsno serious limitationsserious2serious3serious4reporting bias5774755–MD 0.13 higher (0.02 to 0.23 higher)⊕○○○
VERY LOW		IMPORTANT
HRQoL using CRQ emotional domain (follow-up 84–90 days; measured with: absolute scores; better indicated by higher values)
5randomised trialsno serious limitationsserious2serious3serious4reporting bias5774755–MD 0.17 higher (0.05 to 0.29 higher)⊕○○○
VERY LOW		IMPORTANT
HRQoL using CRQ mastery domain (follow-up 84–90 days; measured with: absolute scores; better indicated by higher values)
5randomised trialsno serious limitationsserious2serious3serious4reporting bias5774755–MD 0.18 higher (0.06 to 0.3 higher)⊕○○○
VERY LOW		IMPORTANT
Breathlessness (follow-up 84–90 days; measured with: symptom scores; range of scores: 0–3; better indicated by lower values)
5randomised trialsno serious limitationsserious2serious3serious4reporting bias5776757–MD 0.00 higher (0.09 lower to 0.09 higher)⊕○○○
VERY LOW		IMPORTANT
Cough (follow-up 84–90 days; measured with: symptom score scale from: 0–3; range of scores: 0–3; better indicated by lower values)
5randomised trialsno serious limitationsserious2serious3serious4reporting bias5776757–MD 0.08 lower (0.13 to 0.03 lower)⊕○○○
VERY LOW		IMPORTANT
Wheeze (follow-up 84–90 days; measured with: symptom scale scores from 0–3; range of scores: 0–3; better indicated by lower values)
5randomised trialsno serious limitationsserious2serious3serious4reporting bias5776757–MD 0.04 lower (0.13 lower to 0.04 higher)⊕○○○
VERY LOW		–
Sputum production
0no evidence availablenone–––––IMPORTANT'
-0%-
Distance walked in 6-minute walk test (follow-up 30–42 days; measured with: metres; better indicated by higher values)
2randomised trialsserious6serious2serious3serious4reporting bias5206217–MD 62.6 higher (15.65 lower to 140.85 higher)⊕○○○
VERY LOW		IMPORTANT
Medication-related adverse events (follow-up 42–85 days; assessed with: number of patients with adverse events)
6randomised trialsno serious limitationsserious2serious3serious4reporting bias584/928 (9.1%)111/930 (11.9%)OR 0.71 (0.53 to 0.97)32 fewer per 1000 (from 3 fewer to 52 fewer)⊕○○○
VERY LOW		CRITICAL
–0%–
–0%–
Number of subjects adding or increasing systemic (oral) corticosteroids (follow-up mean 85 days; assessed with: number of subjects)
4randomised trialsno serious limitationsserious2serious3serious4reporting bias552/612 (8.5%)93/606 (15.3%)OR 0.52 (0.37 to 0.74)67 fewer per 1000 (from 35 fewer to 91 fewer)⊕○○○
VERY LOW		IMPORTANT
–10%45 fewer per 1000 (from 24 fewer to 61 fewer)
–22%92 fewer per 1000 (from 47 fewer to 126 fewer)
FEV1 (follow-up 30–90 days; measured with: litres; better indicated by higher values)
8randomised trialsserious6serious2serious3serious4reporting bias510861062–MD 0.03 higher (0 to 0.06 higher)⊕○○○
VERY LOW		IMPORTANT
FVC (follow-up 30–90 days; measured with: litres; better indicated by higher values)
8randomised trialsserious6serious2serious3serious4reporting bias510861062–MD 0.07 higher (0.01 to 0.14 higher)⊕○○○
VERY LOW		IMPORTANT
PEFR (assessed with: litres per minute)
0none–––––IMPORTANT
1

Outcome is not reported in the review.

2

Difference in fomulations, comparators, duration and concomitant medications.

3

Patient population is not from LMICs.

4

Events rate is low and/or sample size is not calculated.

5

Literature search up to 3 July 2008.

6

One study is open label.

From: Annex 4, Grade tables

Cover of Prevention and Control of Noncommunicable Diseases
Prevention and Control of Noncommunicable Diseases: Guidelines for Primary Health Care in Low Resource Settings.
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