Grade table 4

Question: HFA-beclometasone 12 weeks or more for chronic asthma

Settings:

Bibliography: Adams NP et al. (3)

Quality assessmentSummary of findingsImportance
No of patientsEffectsQuality
No of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsHFA-beclometasone 12 weeks or moreControlRelative (95% CI)Absolute
Exacerbation of asthma – adults
1randomised trialsserious1serious2no serious indirectnessserious3none9/91 (9.9%)7/87 (8%)RR 1.23 (0.48 to 3.16)19 more per 1000 (from 42 fewer to 174 more)⊕○○○
VERY LOW		IMPORTANT
Exacerbation of asthma – children
1randomised trialsno serious limitationserious2no serious indirectnessserious3none2/120 (1.7%)6/116 (5.2%)RR 0.32 (0.07 to 1.56)35 fewer per 1000 (from 48 fewer to 29 more)⊕⊕○○
LOW		IMPORTANT
Increased asthma symptoms – adults
1randomised trialsserious1serious2no serious indirectnessno serious imprecision3none1/113 (0.9%)9/117 (7.7%)RR 0.12 (0.01 to 0.89)68 fewer per 1000 (from 8 fewer to 76 fewer)⊕⊕○○
LOW		IMPORTANT
Increased asthma symptoms– children
1randomised trialsno serious limitationserious2no serious indirectnessserious3none14/120 (11.7%)22/116 (19%)RR 0.62 (0.33 to 1.14)72 fewer per 1000 (from 127 fewer to 27 more)⊕⊕○○
LOW		IMPORTANT
FEV1 (% predicted change from baseline) – children (better indicated by lower values)
1randomised trialsno serious limitationserious2no serious indirectnessno serious imprecisionnone120116–MD 5.54 higher (2.23 to 8.85 higher)⊕⊕⊕○
MODERATE		–
FEV1 (% predicted change from baseline) – adults (better indicated by lower values)
1randomised trialsserious1serious2no serious indirectnessno serious imprecisionnone9187–MD 6.3 higher (2.77 to 9.83 higher)⊕⊕○○
LOW		–
Change in morning PEF (litres per minute) – adults (better indicated by lower values)
2randomised trialsserious1serious4no serious indirectnessno serious imprecisionnone204204–MD 40.49 higher (30.09 to 50.89 higher)⊕⊕○○
LOW		–
Change in beta2 agonist use (puffs per day) – adults (better indicated by lower values)
2randomised trialsserious1serious4no serious indirectnessno serious imprecisionnone204204–MD 1.05 lower (1.82 to 0.27 lower)⊕⊕○○
LOW		–
Change in beta2 agonist use (puffs per day) – children (better indicated by lower values)
1randomised trialsno serious limitationserious2no serious indirectnessno serious imprecisionnone120116–MD 0.29 lower (0.61 lower to 0.03 higher)⊕⊕⊕○
MODERATE		–
Abnormal responses to low-dose adrenocorticotropic hormone (ACTH) stimulation – children
1randomised trialsno serious limitationserious2no serious indirectnessserious3none0/22 (0%)3/20 (15%)not poolednot pooled⊕⊕○○
LOW		IMPORTANT
1

Allocation concealment unclear.

2

Cannot be assessed in a single study.

3

CI includes clinically important harm and benefits.

4

Statistically significant heterogeneity.

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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