Summary of findings 3. Inhalation during compared with after airway clearance techniques for cystic fibrosis.
| Inhalation during compared with after airway clearance techniques for cystic fibrosis | ||||||
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Patient or population: adults and children with cystic fibrosis Settings: outpatients Intervention: inhalation during airway clearance techniques Comparison: Inhalation after airway clearance techniques | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of Participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Inhalation after airway clearance techniques | Inhalation during airway clearance techniques | |||||
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FEV1 % predicted Follow‐up: before treatment to 2 hours later |
Not reported1 | The mean FEV1 (% predicted) was 0.03% lower (1.19% lower to 1.12% higher) in the inhalation during airway clearance techniques. | NA | 50 (1 study) | ⊕⊕⊖⊖ low2,3 |
FEV1 (L) also showed no statistically significant difference between groups. Participants received both inhalation approaches as cross‐over design. |
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FVC % predicted Follow‐up: before treatment to 2 hours later |
Not reported1 | The mean FVC (% predicted) was 0.44% lower (3.34% lower to 2.46% higher) in the inhalation during airway clearance techniques. | NA | 50 (1 study) | ⊕⊕⊖⊖ low2,3 |
FVC (L) also showed no statistically significant difference between groups. Participants received both inhalation approaches as cross‐over design. |
| QoL | Outcome not reported. | NA | NA | NA | ||
| Symptom scores | See comments. | NA | 50 (1 study) | ⊕⊕⊖⊖ low2,3 |
Three symptom scores have been presented: Perceived efficacy shows a statistically significant difference in favour of inhalation during airway clearance techniques, MD 15.60 (95% CI 7.55 to 23.65) Tolerability showed no statistically significant difference between groups. Satisfaction shows a statistically significant difference in favour of inhalation during airway clearance techniques, MD 14.80 (95% CI 5.70 to 23.90) |
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| Measures of sputum clearance | Outcome not reported. | NA | NA | NA | ||
| LCI | Outcome not reported. | NA | NA | NA | ||
| Adverse events | Outcome not reported. | NA | NA | NA | ||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; FEV1: forced expiratory volume at 1 second; FVC: forced vital capacity; LCI: lung clearance index; MD: Mean difference; QoL: quality of life | ||||||
| GRADE Working Group grades of evidence High certainty: further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: 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 certainty: we are very uncertain about the estimate. | ||||||
1. Only differences between inhalation before and during airway clearance techniques were presented, results within the inhalation during airway clearance techniques were not presented therefore an assumed risk cannot be calculated.
2. Downgraded once due to high risk due to lack of blinding of participants and personnel.
3. Downgraded once for lack of applicability as studies included only adults so results are not applicable to children.