TABLE 3.

ILLUSTRATIVE EXAMPLES OF COMPARATIVE EFFECTIVENESS RESEARCH TOPICS FOR LUNG DISEASES AND SLEEP DISORDERS

Lung Condition	Sample CER Research Topic	Some Design Considerations
Asthma	Compare alternative treatments (inhaled corticosteroids, leukotriene receptor antagonists, and combination ICS and β-agonists) in children (12–60 months old) who experience frequent severe wheezing episodes.	Stratify study population by asthma phenotypes and biomarkers, including glucocorticoid responsiveness, to identify predictors of variations in response to therapy.
	Compare adjunctive treatments (behavioral intervention using electronic message prompts to enhance adherence vs. LABA) in patients 12–20 years old who have asthma poorly controlled on low to moderate dose of inhaled corticosteroids alone.
	Compare alternative strategies to step-down from a LABA after the patient's asthma becomes well controlled.	Gradually reduce dose of LABA while sustaining ICS dose, remove LABA and increase ICS dose, remove LABA and add either tiotropium or leukotriene receptor antagonist.
COPD	Compare usual care to usual care plus an evidence-based checklist for treatment to improve the quality and outcomes of care among patients with COPD exacerbations.
	Compare in patients who had a hospital admission for COPD exacerbation the effect on functional status and exacerbation relapse of usual care vs. discharge to a disease self-management pulmonary rehabilitation program.
	What is the comparative effectiveness of using spirometry and symptoms vs. symptoms alone in improving patient-centric outcomes?
Cystic fibrosis	Compare effectiveness of new inhaled antibiotics aztreonam vs. tobramycin as combination therapy vs. cycling or alternating treatment.
	Compare effectiveness of dornase alfa vs. hypertonic saline for chronic treatment of children more than 6 years old.
Acute respiratory care	Compare effectiveness of comprehensive interventions during and after critical respiratory illness treated in the Intensive Care Unit to usual care in improving health outcomes, functional activity levels, and quality of life.	Comprehensive interventions would include physical therapy and pharmacological interventions during critical illness (e.g. neuromuscular electrical stimulation, glucocorticoids, somatostatin to reduce muscular atrophy) and follow up care by multidisciplinary teams (e.g. psychological, physical and occupational therapy specialists)
Sleep apnea	Compare effectiveness, using quasi-experimental methodology (pre vs. post), of a recent CMS policy change that requires providers to track adherence to continuous positive airway pressure through electronic health records on health outcomes, quality of life, and health care use.

Definition of abbreviations: CER = comparative effectiveness research; COPD = chronic obstructive pulmonary disease; ICS = inhaled corticosteroids; LABA = long-acting β-agonists; CMS = Centers for Medicare and Medicaid Services.