Summary of findings for the main comparison. Bronchial thermoplasty compared with any active control for persistent asthma in adults.
| Bronchial thermoplasty compared with any active control for persistent asthma in adults | ||||||
| Patient or population: adult patients with asthma Settings: hospital Intervention: bronchial thermoplasty Comparison: any active control (medical management or sham intervention) | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk5 | Corresponding risk | |||||
| Any active control | Bronchial thermoplasty | |||||
| Quality of life (AQLQ) AQLQ scores1. Scale from 1 to 7 Follow‐up: mean 12 months | Mean quality of life (AQLQ) ranged across control groups from 5.1 to 5.7 | Mean quality of life (AQLQ) in the intervention groups was 0.28 higher (0.07 to 0.50 higher) | 429 (3 studies) | ⊕⊕⊕⊝ moderate2,3 | ||
| Asthma control (ACQ) ACQ scores. Scale from 0 to 36 Follow‐up: mean 12 months | Mean change in asthma control measure (ACQ) ranged across control groups from ‐0.55 to ‐0.01 | Mean change in asthma control measure (ACQ) in the intervention groups was 0.15 lower (0.40 lower to 0.10 higher) | 429 (3 studies) | ⊕⊕⊕⊝ moderate2,3 | ||
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Number of exacerbations Follow up: 12 months |
See comment | See comment | See comment | 409 (2 studies) |
Two trials reported on exacerbations, but we did not pool the data. AIR showed no significant differences in the data on number of severe exacerbations per participant per week, with participants in both groups experiencing a decrease at 12 months. AIR 2 reported that the rate of severe exacerbations per participant per year was significantly lower in participants who received bronchial thermoplasty compared with controls (0.48 ± 0.067 vs 0.70 ± 0.122 exacerbations per patient‐year, respectively). In the bronchial thermoplasty group, a significantly lower proportion of participants experienced severe exacerbations compared with controls (26% of participants vs 40%, respectively) |
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| Participants admitted to hospital because of respiratory adverse events (treatment period) Follow‐up: mean 12 weeks | Two per 100 | Eight per 100 (three to 23) | RR 3.5 (1.26 to 9.68) | 429 (3 studies) | ⊕⊕⊕⊕ high |
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| Participants admitted to hospital because of respiratory adverse events (post‐treatment period) Follow‐up: mean 12 months | Four per 100 |
Five per 100 (two to 12) |
RR 1.12 (0.44 to 2.85) | 429 (3 studies) | ⊕⊕⊕⊝ moderate4 | |
| Use of rescue medication Short‐acting bronchodilator puffs per week Follow‐up: mean 12 months | Mean use of rescue medication ranged across control groups from ‐9.99 to ‐0.10 puffs per week | Mean use of rescue medication in the intervention groups was 0.68 lower (3.63 lower to 2.28 higher) | 429 (3 studies) | ⊕⊕⊝⊝ low3,4 | ||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes5. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio. | ||||||
| GRADE Working Group grades of evidence. High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1A change in the score of 0.5 points is considered the threshold of clinical relevance (Juniper 1994). 2Two of the included trials (AIR and RISA) were open. 3The imbalance in the RISA trial could bias the effect estimates of the pooled analysis (see Quality of the evidence section in the Discussion). 4Wide confidence interval.
5Median baseline risk in the included studies.