Saturday, March 31, 2018

Its time to revise Asthma Guidelines? Single maintenance and reliever therapy (SMART) decrease asthma exacerbations

Importance  Combined use of inhaled corticosteroids and long-acting β-agonists (LABAs) as the controller and the quick relief therapy termed single maintenance and reliever therapy (SMART) is a potential therapeutic regimen for the management of persistent asthma.
https://jamanetwork.com/journals/jama/fullarticle/2675737
Objective  To conduct a systematic review and meta-analysis of the effects of SMART in patients with persistent asthma.
Data Sources and Study Selection  The databases of MEDLINE via OVID, EMBASE, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews were searched from database inception through August 2016 and updated through November 28, 2017. Two reviewers selected randomized clinical trials or observational studies evaluating SMART vs inhaled corticosteroids with or without a LABA used as the controller therapy and short-acting β-agonists as the relief therapy for patients aged 5 years or older with persistent asthma and reporting on an outcome of interest.
Data Extraction and Synthesis  Meta-analyses were conducted using a random-effects model to calculate risk ratios (RRs), risk differences (RDs), and mean differences with corresponding 95% CIs. Citation screening, data abstraction, risk assessment, and strength of evidence grading were completed by 2 independent reviewers.
Main Outcomes and Measures  Asthma exacerbations.
Results  The analyses included 16 randomized clinical trials (N = 22 748 patients), 15 of which evaluated SMART as a combination therapy with budesonide and formoterol in a dry-powder inhaler. Among patients aged 12 years or older (n = 22 524; mean age, 42 years; 14 634 [65%] were female), SMART was associated with a reduced risk of asthma exacerbations compared with the same dose of inhaled corticosteroids and LABA as the controller therapy (RR, 0.68 [95% CI, 0.58 to 0.80]; RD, −6.4% [95% CI, −10.2% to −2.6%]) and a higher dose of inhaled corticosteroids and LABA as the controller therapy (RR, 0.77 [95% CI, 0.60 to 0.98]; RD, −2.8% [95% CI, −5.2% to −0.3%]). Similar results were seen when SMART was compared with inhaled corticosteroids alone as the controller therapy. Among patients aged 4 to 11 years (n = 341; median age, 8 [range, 4-11] years; 69 [31%] were female), SMART was associated with a reduced risk of asthma exacerbations compared with a higher dose of inhaled corticosteroids as the controller therapy (RR, 0.55 [95% CI, 0.32 to 0.94]; RD, −12.0% [95% CI, −22.5% to −1.5%]) or the same dose of inhaled corticosteroids and LABA as the controller therapy (RR, 0.38 [95% CI, 0.23 to 0.63]; RD, −23.2% [95% CI, −33.6% to −12.1%]).
Conclusions and Relevance  In this meta-analysis of patients with persistent asthma, the use of single maintenance and reliever therapy compared with inhaled corticosteroids as the controller therapy (with or without a long-acting β-agonist) and short-acting β-agonists as the relief therapy was associated with a lower risk of asthma exacerbations. Evidence for patients aged 4 to 11 years was limited.
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7 comments:

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    2. Chronic venous disease
    3. Gonorrhoea
    4. Hiv/aids
    5. Alzheimers disease
    6. Asepsis
    7. Cancer
    8. Cerebrospinal meingtitis
    9. Infertility problems
    10. Als/ebv
    11. Hpv
    12. Enlargement of any type
    13. Getting back ex lover/divorce
    14. Hepatitis a,b,c
    15. Syphilis
    16. Arthritis
    17. Severe atopic dermatitis
    18. Leukaemia/lupus virus and many more....

    ReplyDelete
  5. It's indeed a miracle I can't believe am finally free from herpes virus, am grateful to this powerful herbalist called Dr Perfect.
    I'm Chris Anderson from UK I was sick of herpes for 3 years it affected my relationship with my girlfriend when she find out I was having herpes she left me, I missed her so much because I loved her with all my heart and she always makes me happy she was the source of my happiness I wanted her to come back to me, so I took every treatment and drugs but none could cure my sickness I never lose hope because I believe I will surely get cured and be reunited with my girlfriend again so I went online to search for herpes cure and I came across a comment of a man on how this powerful herbalist cured him of herpes, I didn't hesitate I emailed him and explained my problem to him on how this herpes has affected my relationship he replied my mail and he asked for some information which I gave him and he prepared a herbal cure when he finished preparing the cure he sent it to me and instructed me on how to use it and I did it as I was instructed, five days later I couldn't find any sign of herpes that's was how I was free from herpes virus and he also did a love spell that brought back my ex girlfriend, this was the best thing that have ever happened to me am indeed grateful to Dr Perfect for the help he has rendered to me if you need help to cure your diseases or bring back your ex contact him and get your problems solved at solutiontoallproblems1@gmail.com
    You can also add him up on WhatsApp +12562513614

    He can also cure the following diseases
    1. Herpes virus
    2. Chronic venous disease
    3. Gonorrhoea
    4. Hiv/aids
    5. Alzheimers disease
    6. Asepsis
    7. Cancer
    8. Cerebrospinal meingtitis
    9. Infertility problems
    10. Als/ebv
    11. Hpv
    12. Enlargement of any type
    13. Getting back ex lover/divorce
    14. Hepatitis a,b,c
    15. Syphilis
    16. Arthritis
    17. Severe atopic dermatitis
    18. Leukaemia/lupus virus and many more....

    ReplyDelete
  6. It's indeed a miracle I can't believe am finally free from herpes virus, am grateful to this powerful herbalist called Dr Perfect.
    I'm Chris Anderson from UK I was sick of herpes for 3 years it affected my relationship with my girlfriend when she find out I was having herpes she left me, I missed her so much because I loved her with all my heart and she always makes me happy she was the source of my happiness I wanted her to come back to me, so I took every treatment and drugs but none could cure my sickness I never lose hope because I believe I will surely get cured and be reunited with my girlfriend again so I went online to search for herpes cure and I came across a comment of a man on how this powerful herbalist cured him of herpes, I didn't hesitate I emailed him and explained my problem to him on how this herpes has affected my relationship he replied my mail and he asked for some information which I gave him and he prepared a herbal cure when he finished preparing the cure he sent it to me and instructed me on how to use it and I did it as I was instructed, five days later I couldn't find any sign of herpes that's was how I was free from herpes virus and he also did a love spell that brought back my ex girlfriend, this was the best thing that have ever happened to me am indeed grateful to Dr Perfect for the help he has rendered to me if you need help to cure your diseases or bring back your ex contact him and get your problems solved at solutiontoallproblems1@gmail.com
    You can also add him up on WhatsApp +12562513614

    He can also cure the following diseases
    1. Herpes virus
    2. Chronic venous disease
    3. Gonorrhoea
    4. Hiv/aids
    5. Alzheimers disease
    6. Asepsis
    7. Cancer
    8. Cerebrospinal meingtitis
    9. Infertility problems
    10. Als/ebv
    11. Hpv
    12. Enlargement of any type
    13. Getting back ex lover/divorce
    14. Hepatitis a,b,c
    15. Syphilis
    16. Arthritis
    17. Severe atopic dermatitis
    18. Leukaemia/lupus virus and many more....

    ReplyDelete