Grade table 15

Question: Should short-acting beta2 agonist regular treatment versus short-acting beta2 agonist as needed treatment be used in patients with chronic stable asthma?

Settings: Hospital or community

Bibliography: Walters EH et al. (2) (literature search up to 17 November 2002)

Quality assessmentSummary of findingsImportance
No of patientsEffectsQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsShort-acting beta2 agonists regular treatmentShort-acting beta2 agonist as needed treatmentRelative (95% CI)Absolute
Mortality (assessed with: number of people died)
0no evidence availablenone–––––CRITICAL
-0%–
QoL (follow-up mean 4 weeks1; measured with: AQoL scores; better indicated by higher values)
1randomised trialsno serious limitationsno serious inconsistencyvery serious2no serious imprecisionnone113112–MD 0.01 higher (0.24 lower to 0.26 higher)⊕⊕○○
LOW		IMPORTANT
Whole day symptom scores (follow-up 16–48 weeks; measured with: SMD3; better indicated by lower values)
2randomised trialsno serious limitationsno serious inconsistencyvery serious2no serious imprecisionnone1271216–SMD 0.26 higher (0.00 to 0.52 higher)⊕⊕○○
LOW		IMPORTANT
Daytime symptom scores (follow-up 12–24 weeks; measured with: SMD3; better indicated by lower values)
7randomised trialsno serious limitationsno serious inconsistencyvery serious2no serious imprecisionnone743739–SMD 0.02 lower (0.12 lower to 09 higher)⊕⊕○○
LOW		IMPORTANT
Night time symptom scores (follow-up 12–24 weeks; measured with: SMD; better indicated by lower values)
5randomised trialsno serious limitationsserious4very serious2no serious imprecisionnone571566–SMD 0.11 lower (0.23 lower to 0.02 higher)⊕○○○
VERY LOW		IMPORTANT
% days without asthma (follow-up 12–54 weeks; measured with: % days; better indicated by higher values)
4randomised trialsno serious limitationsno serious inconsistencyvery serious2no serious imprecisionnone784759–MD 6.70 higher (2.68 to 10.72 higher)⊕⊕○○
LOW		IMPORTANT
% nights with no asthma awakenings (follow-up 4–52 weeks; measured with: % nights; better indicated by lower values)
7randomised trialsno serious limitationsno serious inconsistencyvery serious2no serious imprecisionnone10931084–MD 0.22 lower (3.60 lower to 3.17 higher)⊕⊕○○
LOW		IMPORTANT
Distance walked (assessed with: metres)
0no evidence availablenone–––––IMPORTANT
–0%–
Drop-out (assessed with: number of patients)
0no evidence availablenone–––––NOT IMPORTANT
–0%–
All drug-related adverse events (follow-up 12–24 weeks; assessed with: number of patients with one or more adverse event)
4randomised trialsno serious limitationsno serious inconsistencyvey serious2no serious imprecisionnone74/376 (19.7%)72/376 (19.1%)OR 1.03 (0.72 to 1.49)5 more per 1000 (from 46 fewer to 69 more)⊕⊕○○
LOW		CRITICAL
–10%3 more per 1000 (from 26 fewer to 42 more)
–24%5 more per 1000 (from 55 fewer to 80 more)
Palpitation/tachycardia (follow-up mean 12 weeks; assessed with: number of patients with palpitation/tachycardia)
2randomised trialsno serious limitationsno serious inconsistencyvey serious2no serious imprecisionnone6/258 (2.3%)4/260 (1.5%)OR 1.02 (0.63 to 1.65)1 more per 1000 (from 22 fewer to 36 more)⊕⊕○○
LOW		CRITICAL
–0%–
Headache (follow-up mean 12 days; assessed with: number of patients with headache)
5randomised trialsno serious limitationsno serious inconsistencyvey serious2no serious imprecisionnone37/584 (6.3%)36/581 (6.2%)OR 1.52 (0.42 to 5.46)8 more per 1000 (from 9 fewer to 63 more)⊕⊕○○
LOW		CRITICAL
–0%–
Tremors (follow-up 12-52 weeks; assessed with: number of patients with tremors)
3randomised trialsno serious limitationsno serious inconsistencyvey serious2no serious imprecisionnone25/763 (3.3%)1/751 (0.13%)OR 13.47 (3.17 to 57.24)16312 more per 1,000,000 (from 2877 more to 69577 more)⊕⊕○○
LOW		–
–0%–
FEV1 (follow-up 4–24 weeks; measured with: litres; better indicated by higher values)
9randomised trialsno serious limitationsserious5very serious2no serious imprecisionnone7497346–MD 0.08 lower (0.15 to 0.01 lower)⊕○○○
VERY LOW		IMPORTANT
Change in FEV1 (follow-up 12–16 weeks; measured with: litres; better indicated by higher values)
3randomised trialsno serious limitationsserious7very serious2no serious imprecisionnone166162–MD 0.07 lower (0.19 lower to 0.06 higher)⊕○○○
VERY LOW		IMPORTANT
Morning PEFR (follow-up 4–52 weeks; measured with: litres; better indicated by higher values)
11randomised trialsno serious limitationsno serious inconsistencyvery serious2no serious imprecisionnone12991277–MD 2.70 lower (10.41 lower to 5.02 higher)⊕⊕○○
LOW		CRITICAL
Evening PEFR (follow-up 12–52 weeks; measured with: litres; better indicated by higher values)
8randomised trialsno serious limitationsno serious inconsistencyvery serious2no serious imprecisionnone11591139–MD 3.70 higher (4.65 lower to 12.05 higher)⊕⊕○○
LOW		–
1

Run-in period to establish baseline data of six weeks.

2

Patient population is not from LMICs.

3

Different ordinal scales used; results are analysed using SMD.

4

I-square=74%.

5

I-square=46%.

6

Final values.

7

I-square=84%.

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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