tailieunhanh - Báo cáo y học: " Withdrawal of inhaled corticosteroids in individuals with COPD - a systematic review and comment on trial methodology"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học 'Respiratory Research cung cấp cho các bạn kiến thức về ngành y đề tài: " Withdrawal of inhaled corticosteroids in individuals with COPD - a systematic review and comment on trial methodology. | Nadeem et al. Respiratory Research 2011 12 107 http content 12 1 107 RESPIRATORY RESEARCH REVIEW Open Access Withdrawal of inhaled corticosteroids in individuals with COPD - a systematic review and comment on trial methodology Nighat J Nadeem Stephanie JC Taylor and Sandra M Eldridge Abstract Inhaled corticosteroids ICS reduce COPD exacerbation frequency and slow decline in health related quality of life but have little effect on lung function do not reduce mortality and increase the risk of pneumonia. We systematically reviewed trials in which ICS have been withdrawn from patients with COPD with the aim of determining the effect of withdrawal understanding the differing results between trials and making recommendations for improving methodology in future trials where medication is withdrawn. Trials were identified by two independent reviewers using MEDLINE EMBASE and CINAHL citations of identified studies were checked and experts contacted to identify further studies. Data extraction was completed independently by two reviewers. The methodological quality of each trial was determined by assessing possible sources of systematic bias as recommended by the Cochrane collaboration. We included four trials the quality of three was adequate. In all trials outcomes were generally worse for patients who had had ICS withdrawn but differences between outcomes for these patients and patients who continued with medication were mostly small and not statistically significant. Due to data paucity we performed only one meta-analysis this indicated that patients who had had medication withdrawn were 95 CI to times more likely to have an exacerbation in the following year but the definition of exacerbations was not consistent between the three trials and the impact of withdrawal was smaller in recent trials which were also trials conducted under conditions that reflected routine practice. There is no evidence from this review that withdrawing