Grade table 3

Question: CFC-beclometasone studies over four weeks for chronic asthma

Settings:

Bibliography: Adams NP et al. (3)

Quality assessmentSummary of findingsImportance
No of patientsEffectsQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsCFC-beclometasone studies over 4 weeksControlRelative (95% CI)Absolute
Withdrawals due to asthma exacerbation – adults
9randomised trialsserious1,2no serious inconsistencyno serious indirectness3no serious imprecisionnone15/470 (3.2%)60/365 (16.4%)RR 0.25 (0.15 to 0.42)123 fewer per 1000 (from 95 fewer to 140 fewer)⊕⊕⊕○
MODERATE		IMPORTANT
Withdrawals due to asthma exacerbation – children
2randomised trialsserious1,2no serious inconsistencyno serious indirectness3no serious imprecisionnone5/91 (5.5%)17/90 (18.9%)RR 0.31 (0.12 to 0.78)130 fewer per 1000 (from 42 fewer to 166 fewer)⊕⊕⊕○
MODERATE		IMPORTANT
Daytime asthma symptoms score (change from baseline) – adults (better indicated by lower values)
2randomised trialsserious1,2no serious inconsistencyno serious indirectness3no serious imprecisionnone313298–MD 0.65 lower (1.08 to 0.22 lower)⊕⊕⊕○
MODERATE		IMPORTANT
FEV1 (% predicted) – adults (better indicated by lower values)
5randomised trialsserious1,2no serious inconsistencyno serious indirectness3serious4none7662–MD 6.54 higher (2.98 lower to 16.07 higher)⊕⊕○○
LOW		–
FEV1 (% predicted) – children (better indicated by lower values)
1randomised trialsserious1serious5no serious indirectness3serious6none1315–MD 2.92 higher (6.98 lower to 12.82 higher)⊕○○○
VERY LOW		–
Change in morning PEF (litres per minute) – adults (better indicated by lower values)
4randomised trialsserious1,2no serious inconsistencyno serious indirectness3no serious imprecisionnone596516–MD 39.05 higher (31.95 to 46.15 higher)⊕⊕⊕○
MODERATE		–
Daily use of beta2 agonists (puffs per day) – adults (better indicated by lower values)
3randomised trialsserious1no serious inconsistency7no serious indirectness3no serious imprecisionnone190104–MD 1.98 lower (2.34 to 1.62 lower)⊕⊕⊕○
MODERATE		–
Oropharyngel side effect – adults
3randomised trialsserious1no serious inconsistencyno serious indirectness3serious6none8/201 (4%)4/115 (3.5%)RR 1.62 (0.56 to 4.65)22 more per 1000 (from 15 fewer to 127 more)––
1

Few trials have clear descriptions of sequence generation and allocation concealment (although most are described as double-blind).

2

Results from high-quality studies only show significant benefit.

3

CFC propellants are unlikely to change results.

4

Significant heterogeneity between study results.

5

Cannot be assessed in a single study.

6

CI includes clinically important harm and benefits.

7

All trials show clinically significant benefit with beclometasone.

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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