11. Symptom scores.
| Intervention/Comparison | Outcome | Results: treatment effect (95% CI) unless otherwise stated | Number of participants (studies) | Certainty of the evidence (GRADE) | Comments: overview authors' assessment of the certainty of evidence |
| Continuous vs intermittent nebulisation (Camargo 2003) | Symptom scores | SMD 0.66 (0.18 to 1.14) | 70 (1) | Low | Certainty downgraded due to serious imprecision and serious risk of bias of the single study; unclear sequence generation; no allocation concealment (single‐blind study) |
| Anticholinergic and SABA vs SABA alone (Griffiths 2013) | Change in clinical score at 120 minutes (± 30 minutes) | SMD ‐0.23 (‐0.42 to ‐0.04) | 934 (3) | Moderate | Certainty downgraded due to risk of bias in review (single author selected possible citations) |
| Oral LTRA vs control (Watts 2012) | Change in pulmonary index score (final assessment) | MD ‐1.20 (‐1.37 to ‐1.03) | 50 (1) | High | |
| Heliox vs placebo for non‐intubated asthma patients (Rodrigo 2006) | Dyspnoea or pulmonary index | MD ‐0.51 (‐1.14 to 0.11) | 93 (3) | Low | Risk of serious imprecision. SR shows asymmetrical funnel plot, suggesting publication bias |
| Inhaled anticholinergics + SABA vs SABA alone for children hospitalised with asthma (Vezina 2014) | Asthma clinical scores 8 to 36 hours after initial treatment | SMD 0.02 (‐0.34 to 0.38) | 117 (2) | Low | Certainty downgraded due to risk of bias in review (single author selected possible citations) and serious imprecision |
| Inhaled magnesium sulfate (Knightly 2017) | Yung asthma severity score at 60 minutes | MD ‐0.23 (‐0.48 to 0.02) | 472 (1) | Moderate | Certainty downgraded due to risk of bias in review (single author decided on trial inclusion) |
| IV aminophylline + SABA + systemic steroids vs placebo + SABA + systemic steroids (Mitra 2005) |
Change in symptom scores 6 to 8 hours after enrolment (all patients) | SMD ‐0.42 (‐0.70 to ‐0.13) | 215 (3) | Low | Certainty downgraded due to serious imprecision and risk of bias in review (single author reviewed each abstract) |
| Change in symptom scores 6 to 8 hours after enrolment: submaximal inhaled beta‐2 agonists (< 45 mg/kg/h) | SMD ‐0.31 (‐0.94 to 0.32) | 39 (1) | Low | Certainty downgraded due to serious imprecision and risk of bias in review (single author reviewed each abstract) | |
| Change in symptom scores 6 to 8 hours after enrolment: maximised inhaled beta‐2 agonists (≥ 45 mg/kg/h) | Not estimable | 21 (1) | Very low | Certainty downgraded due to very serious imprecision and risk of bias in review (single author reviewed each abstract) | |
| Change in symptom scores 6 to 8 hours after enrolment: maximised inhaled beta‐2 agonists (≥ 45 mg/kg/h) and anticholinergics | SMD ‐0.45 (‐0.77 to ‐0.13) | 155 (1) | Low | Certainty downgraded due to serious imprecision and risk of bias in review (single author reviewed each abstract) | |
| Change in symptom scores 12 to 18 hours after enrolment: submaximal inhaled beta‐2 agonists (< 45 mg/kg/h) | SMD ‐0.45 (‐1.09 to 0.19) | 39 (1) | Low | Certainty downgraded due to serious imprecision and risk of bias in review (single author reviewed each abstract) | |
| Change in symptom scores 12 to 18 hours after enrolment: maximised inhaled beta‐2 agonists (≥ 45 mg/kg/h) | Not estimable | 21 (1) | Very low | Certainty downgraded due to very serious imprecision and risk of bias in review (single author reviewed each abstract) | |
| Change in symptom scores 24 hours after enrolment (all patients) | SMD ‐0.13 (‐0.52 to 0.25) | 127 (4) | Low | Certainty downgraded due to serious imprecision and risk of bias in review (single author reviewed each abstract) | |
| Change in symptom scores 24 hours after enrolment: submaximal inhaled beta‐2 agonists (< 45 mg/kg/h) | Not estimable | 21 (1) | Very low | Certainty downgraded due to very serious imprecision and risk of bias in review (single author reviewed each abstract) | |
| Change in symptom scores 24 hours after enrolment: maximised inhaled beta‐2 agonists (≥ 45 mg/kg/h) and anticholinergics | SMD ‐0.13 (‐0.52 to 0.25) | 127 (4) | Low | Certainty downgraded due to serious imprecision and risk of bias in review (single author reviewed each abstract) | |
| IV ketamine vs placebo (Jat 2012) | Pulmonary Index Score | MD 0.40 (‐1.21 to 0.41) | 68 (1) | Moderate | Certainty downgraded due to serious imprecision |
| Non‐invasive positive‐pressure ventilation (Korang 2016) | Asthma symptom score in the acute phase | MD ‐2.50 (‐4.70 to ‐0.30) | 19 (1) | Moderate | Certainty downgraded due to risk of bias in included study |
CI: confidence interval; GRADE: Grading of Recommendations Assessment, Development and Evaluation; LTRA: leukotriene receptor antagonist; MD: mean difference; mg/kg: milligram per kilogram; SABA: short‐acting beta2‐agonist; SMD: standardised mean difference; SR: systematic review.