Short-acting beta2-agonists for stable chronic obstructive pulmonary disease

Sestini, Piersante; Renzoni, Elisabetta A.; Robinson, Stewart M.; Poole, Phillippa; Ram, Felix S F

doi:10.1002/14651858.cd001495

Cited by 72 publications

(50 citation statements)

References 49 publications

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“…23,24 Our finding that newly identified cases tended to have mild or moderate airflow obstruction was in keeping with previous case-finding studies 10 and newly case-found patients were generally less severe than patients newly diagnosed in primary care. 25 Nevertheless, in accordance with our model, the majority of new cases could potentially benefit from inhalers, 26,27 self-management support, 28 smoking cessation 29 and vaccinations. 30 A substantial proportion (27%) also had significant breathlessness with potential to benefit from pulmonary rehabilitation.…”

supporting

confidence: 72%

Targeted case finding for chronic obstructive pulmonary disease versus routine practice in primary care (TargetCOPD): a cluster-randomised controlled trial

Jordan

Adab

Sitch

et al. 2016

The Lancet Respiratory Medicine

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Word count: 4222 3 RESEARCH IN CONTEXT Evidence before this studyIt is widely accepted that COPD is substantially under-diagnosed worldwide. Mass population screening with spirometry is not recommended although early identification of undiagnosed patients with clinical disease is generally supported because COPD has significant patient, healthcare and societal burden which could potentially be lessened through timely diagnosis. A comprehensive systematic review of the effectiveness of case-finding studies, published in 2015, revealed 39 published studies but few included a comparator arm. Only one RCT has compared a case-finding approach with routine care to identify clinically significant COPD, identifying that opportunistic administration of a screening questionnaire at practice visits was twice as effective as routine care, but non-comparative studies suggest that high yields could be achieved from active case finding with mailed questionnaires to high risk patients. No previous trial has compared the clinical and costeffectiveness of alternative approaches to case-finding in a real-life primary care setting. Added value of this studyTargetCOPD is the first randomised controlled trial to evaluate the effectiveness and costeffectiveness of active case-finding for COPD compared with opportunistic case finding and to compare these approaches with routine care. Among 54 general practices, we found that when targeting ever smokers aged 40-79 years, active case finding was more than twice as effective as opportunistic case finding, and that together, these targeted approaches were over seven times as effective as current routine care. Active case finding was also more cost-effective than opportunistic case finding. Implications of all the available evidenceIn a real-life setting, active case-finding comprising an initial mailed questionnaire followed by spirometry should be recommended for identifying undiagnosed COPD in primary care. An important proportion of these previously undiagnosed patients have significant breathlessness and earlier identification and management with effective treatments including inhalers and pulmonary rehabilitation has the potential to improve their health. This trial provides the evidence for guidelines which was previously lacking. 4 SUMMARY Background

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supporting

confidence: 72%

Targeted case finding for chronic obstructive pulmonary disease versus routine practice in primary care (TargetCOPD): a cluster-randomised controlled trial

Jordan

Adab

Sitch

et al. 2016

The Lancet Respiratory Medicine

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“…From our limited results, few reviewers reported the correlations they ''borrowed'' from other studies. Furthermore, the few available correlations (reported or gathered from included authors) for change-from-baseline SD did not all exceed the critical value of 0.5 although most did: 0.07 to 0.56 [34], 0.46 to 0.74 [35], 0.63 to 0.90 [36], 0.75 [37], 0.82 [38], 0.9 [39]. Three sets of sensitivity analyses were used: 0.3, 0.4, and 0.5; 0.25, 0.5, and 0.75; and 0, and 0.5.…”

Section: Study-level Imputation Of Correlationmentioning

confidence: 95%

A systematic review identifies a lack of standardization in methods for handling missing variance data

Wiebe

Vandermeer

Platt

et al. 2006

Journal of Clinical Epidemiology

254

193

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“…In addition to their bronchodilatory properties, these agents are effective in increasing mucociliary clearance. A systematic review showed that regular use of short-acting beta-agonists in COPD was associated with improvement in lung function and dyspnoea (29). The two currently available LABAs -salmeterol and formoterol -have been shown significantly to improve lung function, health status, and symptom reduction, compared with both placebo (16,(30)(31)(32) and ipratropium (21,33).…”

Section: Clinical Benefitsmentioning

confidence: 99%