We recorded the selection process in sufficient fine detail to complete a PRISMA circulation diagram and Characteristics of excluded studies table
We recorded the selection process in sufficient fine detail to complete a PRISMA circulation diagram and Characteristics of excluded studies table. Data extraction and management We used a data collection form in Covidence for study characteristics and end result data, which was piloted on at least one study in the review. receive LAMA add\on or LABA add\on for at least 12 weeks. Data collection and analysis Two evaluate authors individually screened the electronic and additional searches and extracted data from study reports. We used Covidence for duplicate testing, extraction of study characteristics and numerical data, and risk of bias ratings. The pre\specified primary outcomes were exacerbations requiring oral corticosteroids (OCS), quality of life and serious adverse events. Main results We included eight studies meeting the inclusion criteria, but four double\blind, double\dummy studies of around 2000 people dominated the analyses. These four tests were between 14 and 24 weeks very long, all comparing tiotropium (usually Respimat) with salmeterol on top of medium doses of ICS. Studies reporting exacerbations requiring OCS showed no difference between the two add\ons, but our confidence in the effect was low due to inconsistency between studies and because the confidence intervals (CI) included significant good thing about either treatment (odds percentage (OR) 1.05, 95% CI 0.50 to 2.18; 1753 participants; 3 studies); three more people per 1000 might have an exacerbation on LAMA, but the CIs ranged from 29 fewer to 61 more. Imprecision was also an issue for severe adverse events and exacerbations requiring hospital admission, rated low (serious adverse events) and very low quality (exacerbations requiring hospital admission), because there were so few events in the analyses. People taking LAMA scored slightly worse on two scales measuring quality of life (Asthma Quality of Life Questionnaire; AQLQ) and asthma control (Asthma Control Questionnaire; ACQ); the evidence was rated high quality but the effects were small and unlikely to be clinically significant (AQLQ: mean difference (MD) \0.12, 95% CI \0.18 to \0.05; 1745 participants; 1745; 4 studies; ACQ: MD 0.06, 95% CI 0.00 to Itga4 0.13; 1483 participants; 3 studies). There was some evidence to support small benefits of LAMA over LABA on lung function, including on our pre\specified favored measure trough forced expiratory volume in one second (FEV1) (MD 0.05 L, 95% CI 0.01 to 0.09; 1745 participants, 4 studies). However, the effects on other measures varied, and it is not clear whether the magnitude of the differences were clinically significant. More people had adverse events on LAMA but the difference with LABA was not statistically significant. Authors’ conclusions Direct evidence of LAMA versus LABA as add\on therapy is currently limited to studies of less than six months comparing tiotropium (Respimat) to salmeterol, and we do not know how they compare in terms of exacerbations and serious adverse events. There was moderate quality evidence that LAMAs show small benefits over LABA on some steps of lung function, and high quality evidence that LABAs are slightly better for quality of life, but the differences were all small. Given the much larger evidence base for LABA versus placebo for people whose asthma is not well controlled on ICS, the current evidence is not strong enough to say that LAMA can be substituted for LABA as add\on therapy. The results of this review, alongside pending results from related reviews assessing the use of LAMA in other clinical scenarios, will help to define the role of these drugs in asthma and it is important that they be updated as results from ongoing and planned trials emerge. emergency department visit), we analysed these separately. Search methods for identification of studies Electronic searches We Atracurium besylate identified trials from the Cochrane Airways Group’s Specialised Register (CAGR), which is usually maintained by the Trials Search Co\ordinator for the Group. The Register contains trial reports identified through systematic searches of bibliographic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, Atracurium besylate CINAHL, AMED and PsycINFO, and handsearching of respiratory journals and getting together with abstracts (see Appendix 1 for further details). We searched all records in the CAGR using the search strategy in Appendix 2. We also conducted a search of ClinicalTrials.gov (www.ClinicalTrials.gov), the World Health Business (WHO) trials portal (www.who.int/ictrp/en/) and industry trial registries. We searched all databases from their inception to April 2015, and we imposed no restriction on language Atracurium besylate of publication. Searches were.